title: New specimens and laboratory diagnostics for childhood pulmonary TB: progress and prospects.
abstract: Childhood pulmonary TB (PTB) is under diagnosed, in part due to difficulties in obtaining microbiological confirmation. However, given the poor specificity of clinical diagnosis, microbiological confirmation and drug susceptibility testing is important in guiding appropriate therapy especially in the context of drug resistant TB. Confirmation is often possible, even in infants and young children, if adequate specimens are collected. Culture yield varies with the severity of illness, specimen type and culture method. Induced sputum is recognised as a safe procedure with a high diagnostic yield. Advances include optimised protocols for smear microscopy and modified culture techniques, such as the Microscopic Observation Drug Susceptibility Assay. Detection of Mycobacterium tuberculosis nucleic acid in respiratory specimens has high specificity but relatively poor sensitivity, particularly for smear negative disease. The recent development of an integrated specimen processing and real-time PCR testing platform for M. tuberculosis and rifampicin resistance is an important advance that requires evaluation in childhood TB.
authors.affiliation: Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and National Health Laboratory Service of South Africa. Mark.Nicol@uct.ac.za
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D000367:Age Factors; D002648:Child; D006801:Humans; D008828:Microbiological Techniques; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology*