Pediatric TB diagnostics: Unraveling the challenges, plugging the loopholes

Dr Pavan Asalapuram, Co-Founder, EMPE Diagnostics highlights that whether it’s in India or any other part of the world, the burden of childhood TB must be given the attention it deserves, and the first step is to identify and adopt more precise and sensitive diagnostic tools

Tuberculosis (TB), a disease that has plagued the world for centuries, is still a major health crisis in developing nations. According to the WHO, there were 10.6 million people living with TB in 2021. In the same breath, India (28 per cent) has the highest number of cases among eight countries that accounted for nearly 70 per cent of global TB cases in 2021, with 2.7 million cases that year. This makes India an epicentre for what is considered a deadly infectious bacterial disease if not properly managed.

Unfortunately, TB does not discriminate on the basis of age, as it also greatly affects children. The prevalence of pediatric TB in India is not clear due to the difficulty encountered in diagnosing the disease in children. Suspicion is limited, and so detection is delayed, making it difficult to identify and begin treatment as early as required. The clinical evolution among children is, to say the least, torpid, and there are no specific signs and symbols to look out for.

Addressing pediatric TB diagnosis

TB in children is mostly pauci-bacillary, which means they do not easily present evidence of disease. There is rarely any sputum so it is difficult to obtain specimens for testing. So, cases have to undergo clinical diagnosis for any meaningful results to be observed. At this stage, more aggressive symptoms would’ve been presented and the disease would have reached an advanced stage. Hence, treatment is more difficult and recovery rate is slim.

The situation is worse in much younger children who may not show well-characterised symptoms and can’t give information about contact with infected adults. The challenge has been largely associated with the limited sensitivity of diagnostic tools which have been used for decades. However, modern innovations have resulted in much more highly sensitive tools for TB diagnosis.

Compared to microscopy, the molecular option has doubled the rate of TB diagnosis in bacteriologically-confirmed cases. Furthermore, most children are negative on culture and, even though the WHO puts the incidence of pediatric TB at 1.2 million as of 2021, it is believed to be far greater than that number by as much as 50 per cent. According to a recent study, mortality rate exceeds 50 per cent in children aged 1 and younger who do not receive an anti-TB medication.

Other test methods for diagnosis like the PCR amplified IS6110 have also been put forward due to its high sensitivity and specificity. Specificity is important because there are many other child diseases that present similar symptoms to tuberculosis. Therefore, health practitioners must look out for precision.

Improved testing for reduced pediatric TB prevalence

Whether it’s in India or any other part of the world, the burden of childhood TB must be given the attention it deserves, and the first step is to identify and adopt more precise and sensitive diagnostic tools. Bottom line is, it is only when newer and more effective diagnostic methods are consistently instituted that childhood TB can be effectively diagnosed, early enough and more precisely. The scarcity of bacilli in children, as well as the difficulty in accessing sputum specimen and gastric lavage all pose serious challenges, but newer and more sensitive tools can make a difference in the control of TB among children.