Diagnosis of pediatric tuberculosis in the modern era.
BACKGROUND
Correctly diagnosing tuberculosis (TB) in children is critical to provide appropriate treatment and to detect undiagnosed source cases. However, diagnosing TB in children may be difficult.


OBJECTIVE
We sought to determine whether Amplicor, a Food and Drug Administration-approved polymerase chain reaction (PCR) assay used to detect Mycobacterium tuberculosis in sputum and computerized tomography (CT) would facilitate the diagnosis of TB in children. We also examined the applicability of the Centers for Disease Control and Prevention clinical case definition for TB.


METHODS
A university-affiliated pediatric hospital in New York City.


METHODS
From March, 1995, to November, 1997, 27 children < 15 years of age (mean age, 3.9 years) were evaluated for suspected TB.


RESULTS
M. tuberculosis was cultured from 5 of 76 (6.6%) gastric aspirate specimens, and PCR detected M. tuberculosis DNA in 3 (4.1%) of these specimens. There was poor correlation between culture and PCR because 6 specimens were discordant. CT scans were diagnostic of mediastinal or hilar adenopathy in 6 children with equivocal or negative chest radiographs and confirmed adenopathy in 8 others. Six children received alternative diagnoses.


CONCLUSIONS
We conclude that the commercially available PCR technology had very limited utility in detecting M. tuberculosis from gastric aspirates, but CT scans were useful in assessing pediatric patients with suspected TB.
Department of Pediatrics, Columbia University, New York, NY 10032, USA.
N
N
Neu
L
L
Saiman
P
P
San Gabriel
S
S
Whittier
C
C
Knirsch
C
C
Ruzal-Shapiro
P
P
Della-Latta
D000293:Adolescent; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005750:Gastric Juice / Q000382:microbiology; D015658:HIV Infections / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014481:United States
D003470:Culture Media; D004269:DNA, Bacterial