Andrew R DiNardo1, Anne Detjen2, Pilar Ustero3, Katherine Ngo4, Jason Bacha5, Anna M Mandalakas6. 1. The Global Tuberculosis Program, Texas Children's Hospital, Global and Immigrant Health, Baylor College of Medicine, Houston, TX, USA. Electronic address: Andrew.DiNardo@bcm.eduu. 2. The International Union Against Tuberculosis and Lung Disease (The Union), 61 Broadway, Suite 1720, New York, NY 10006, USA. Electronic address: adetjen@unicef.org. 3. The Global Tuberculosis Program, Texas Children's Hospital, Baylor College of Medicine Children's Foundation-Swaziland, Baylor College of Medicine, Mbabane, Swaziland. Electronic address: PAlonso@bcm.edu. 4. The Global Tuberculosis Program, Texas Children's Hospital, Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. Electronic address: Katherine.Ngo@bcm.edu. 5. The Global Tuberculosis Program, Texas Children's Hospital, Baylor International Pediatric AIDS Initiative, Baylor Tanzania Center of Excellence, Baylor College of Medicine, Mbeya, Tanzania. Electronic address: Bacha@bcm.edu. 6. The Global Tuberculosis Program, Texas Children's Hospital, Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. Electronic address: Anna.Mandalakas@bcm.edu.
Abstract
BACKGROUND: In pediatric tuberculosis (pTB), culture is the accepted reference standard for assessing new diagnostic tests despite culture only confirming 10-50% of clinically diagnosed cases. METHODS: Using the studies previously included in the systematic review of Gene Xpert, we evaluated the diagnostic yield of culture. Children with symptoms and signs suggestive of TB were considered to have a clinical diagnosis if they were 1) culture positive or 2) followed clinically for at least one month and started on Anti-Tuberculosis Therapy (ATT). RESULTS: Of 1989 children with presumptive pTB, 229 (11.5%) had culture-confirmation. Of the remaining 1760 culture negative children, 710 (24.4) were classified as culture-negative clinical TB and 821 were classified as "not TB". Diagnostic yield of culture was 24.4% (median 28.7% IQR 15.6%-42.4%; range 1.5%-65%). CONCLUSION: Culture, the accepted reference standard for pediatric TB diagnostics, has a low and variable yield that impacts how diagnostic studies should be reported as well as everyday clinical care.
BACKGROUND: In pediatric tuberculosis (pTB), culture is the accepted reference standard for assessing new diagnostic tests despite culture only confirming 10-50% of clinically diagnosed cases. METHODS: Using the studies previously included in the systematic review of Gene Xpert, we evaluated the diagnostic yield of culture. Children with symptoms and signs suggestive of TB were considered to have a clinical diagnosis if they were 1) culture positive or 2) followed clinically for at least one month and started on Anti-Tuberculosis Therapy (ATT). RESULTS: Of 1989 children with presumptive pTB, 229 (11.5%) had culture-confirmation. Of the remaining 1760 culture negative children, 710 (24.4) were classified as culture-negative clinical TB and 821 were classified as "not TB". Diagnostic yield of culture was 24.4% (median 28.7% IQR 15.6%-42.4%; range 1.5%-65%). CONCLUSION: Culture, the accepted reference standard for pediatric TB diagnostics, has a low and variable yield that impacts how diagnostic studies should be reported as well as everyday clinical care.
Authors: Alexander W Kay; Tara Ness; Sabine E Verkuijl; Kerri Viney; Annemieke Brands; Tiziana Masini; Lucia González Fernández; Michael Eisenhut; Anne K Detjen; Anna M Mandalakas; Karen R Steingart; Yemisi Takwoingi Journal: Cochrane Database Syst Rev Date: 2022-09-06
Authors: Micaela Sandoval; Padma Swamy; Alexander W Kay; Pilar Ustero Alonso; Gloria Sisi Dube; Hypertia Hlophe-Dlamini; Anna M Mandalakas Journal: Am J Trop Med Hyg Date: 2020-09-24 Impact factor: 3.707
Authors: Alexander W Kay; Lucia González Fernández; Yemisi Takwoingi; Michael Eisenhut; Anne K Detjen; Karen R Steingart; Anna M Mandalakas Journal: Cochrane Database Syst Rev Date: 2020-08-27
Authors: Elisabetta Walters; Anne-Marie Demers; Marieke M van der Zalm; Andrew Whitelaw; Megan Palmer; Corné Bosch; Heather R Draper; Robert P Gie; Anneke C Hesseling Journal: J Clin Microbiol Date: 2017-09-13 Impact factor: 5.948