Newer Diagnostic Techniques in Pediatric Tuberculosis
Key Points
- Molecular methods offer rapid and accurate diagnosis
- Immunological tests help in latent TB detection
- Advanced imaging techniques improve diagnostic accuracy
- Combined approach increases diagnostic yield
Evolution of TB Diagnostics
- Shift from conventional to rapid molecular testing
- Development of point-of-care tests
- Integration of artificial intelligence in imaging
- Enhanced sensitivity for paucibacillary disease
Molecular Diagnostic Techniques
1. Nucleic Acid Amplification Tests (NAATs)
GeneXpert MTB/RIF and Ultra
- Features:
- Real-time PCR technology
- Simultaneous detection of MTB and rifampicin resistance
- Results within 2 hours
- WHO-recommended as initial diagnostic test
- Ultra Advantages:
- Enhanced sensitivity in children
- Better detection in paucibacillary disease
- Improved performance in HIV co-infection
Line Probe Assays (LPA)
- Types:
- First-line LPA (FL-LPA)
- Second-line LPA (SL-LPA)
- Applications:
- Rapid drug resistance detection
- Guide treatment modification
- Epidemiological surveillance
Loop-mediated Isothermal Amplification (TB-LAMP)
- Advantages:
- Simple equipment requirements
- Rapid results (40-60 minutes)
- Cost-effective
Advanced Immunological Tests
1. Interferon-Gamma Release Assays (IGRAs)
- Types:
- QuantiFERON-TB Gold Plus
- T-SPOT.TB test
- Advantages:
- Not affected by BCG vaccination
- Single patient visit required
- Objective laboratory-based results
- Limitations:
- Cannot differentiate active from latent TB
- Cost considerations
- Blood sample processing time constraints
2. Novel Biomarker Tests
- IP-10 (CXCL10):
- Inflammatory marker
- Higher sensitivity in children
- Potential for point-of-care testing
- LAM Testing:
- Urine-based detection
- Useful in HIV co-infection
- Rapid results available
Advanced Imaging Techniques
1. Digital Chest Radiography
- Computer-Aided Detection (CAD):
- AI-based interpretation
- Standardized reporting
- Enhanced detection of subtle changes
2. Advanced CT Imaging
- Low-dose CT protocols:
- Reduced radiation exposure
- High-resolution imaging
- 3D reconstruction capability
- Applications:
- Lymph node evaluation
- Miliary pattern detection
- Treatment monitoring
3. PET-CT Imaging
- Indications:
- Extrapulmonary TB evaluation
- Treatment response assessment
- Differentiation from malignancy
4. Point-of-Care Ultrasound
- Applications:
- Pleural effusion assessment
- Lymph node evaluation
- Guided procedures
Implementation Considerations
- Cost-effectiveness analysis
- Infrastructure requirements
- Training needs
- Quality assurance programs
- Result interpretation expertise
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
