Diagnostic Challenges in Childhood Pulmonary Tuberculosis—Optimizing the Clinical Approach

Kenneth S. Gunasekera, Bryan Vonasek, Jacquie Oliwa, Rina Triasih, Christina Lancioni, Stephen M. Graham, James A. Seddon, Ben J. Marais

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

The management of childhood tuberculosis (TB) is hampered by the low sensitivity and limited accessibility of microbiological testing. Optimizing clinical approaches is therefore critical to close the persistent gaps in TB case detection and prevention necessary to realize the child mortality targets of the End TB Strategy. In this review, we provide practical guidance summarizing the evidence and guidelines describing the use of symptoms and signs in decision making for children being evaluated for either TB preventive treatment (TPT) or TB disease treatment in high-TB incidence settings. Among at-risk children being evaluated for TPT, a symptom screen may be used to differentiate children who require further investigation for TB disease before receiving TPT. For symptomatic children being investigated for TB disease, an algorithmic approach can inform which children should receive TB treatment, even in the absence of imaging or microbiological confirmation. Though clinical approaches have limitations in accuracy, they are readily available and can provide valuable guidance for decision making in resource-limited settings to increase treatment access. We discuss the trade-offs in using them to make TB treatment decisions.

Original languageEnglish (US)
Article number382
JournalPathogens
Volume11
Issue number4
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • children
  • diagnosis
  • paediatric
  • symptom-based
  • tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Molecular Biology
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

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