title: Improved detection of Mycobacterium tuberculosis in Peruvian children by use of a heminested IS6110 polymerase chain reaction assay.
abstract: A novel heminested IS6110 polymerase chain reaction (PCR) assay was evaluated as a tool for diagnosing tuberculosis in 222 children. In an analysis of 392 specimens (gastric aspirates, nasopharyngeal aspirates, and sputum samples), results of PCR were compared with those of 3 culture methods, acid-fast bacillus (AFB) staining, and clinical assessment by the Stegen-Toledo score. The sensitivity of PCR (67%) was comparable to that of the 3-culture method (71%) and was significantly higher than that of Löwenstein-Jensen culture (54%) or AFB stain (42%) for children with highly probable tuberculosis. PCR detection rates for culture-positive specimens were 100% for smear-positive samples and 76.7% for smear-negative samples. The specificity of PCR was 100% in control children. Compared with culture, PCR demonstrated a sensitivity of 90.4%, a positive predictive value of 89%, a specificity of 94%, and a negative predictive value of 95% (kappa=.85). With clinical assessment as the standard, PCR had a sensitivity of 71%, a positive predictive value of 92%, a specificity of 95%, and a negative predictive value of 79% (kappa=.67). PCR is a rapid and sensitive method for the early diagnosis of pediatric tuberculosis.
authors.affiliation: Molecular Immunogenetics Laboratory, Div. of Research, Ochsner Clinic Foundation, New Orleans, LA 70121, USA. smontenegro@ochsner.org
authors.forename: Sonia H
authors.initials: SH
authors.lastname: Montenegro
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheen
authors.forename: Rosa
authors.initials: R
authors.lastname: Cama
authors.forename: Lucy
authors.initials: L
authors.lastname: Caviedes
authors.forename: Terryl
authors.initials: T
authors.lastname: Hopper
authors.forename: Richard
authors.initials: R
authors.lastname: Chambers
authors.forename: Richard A
authors.initials: RA
authors.lastname: Oberhelman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D010568:Peru / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000379:methods*; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology*