title: Diagnostic accuracy of microscopic Observation Drug Susceptibility (MODS) assay for pediatric tuberculosis in Hanoi, Vietnam.
abstract: BACKGROUND
  Microscopic [corrected] Observation Drug Susceptibility (MODS) has been shown to be an effective and rapid technique for early diagnosis of tuberculosis (TB). Thus far only a limited number of studies evaluating MODS have been performed in children and in extra-pulmonary tuberculosis. This study aims to assess relative accuracy and time to positive culture of MODS for TB diagnosis in children admitted to a general pediatric hospital in Vietnam.
  
  
  RESULTS
  Specimens from children with suspected TB were tested by smear, MODS and Lowenstein-Jensen agar (LJ). 1129 samples from 705 children were analyzed, including sputum (n=59), gastric aspirate (n=775), CSF (n=148), pleural fluid (n=33), BAL (n=41), tracheal fluid (n=45), other (n=28). 113 TB cases were defined based on the "clinical diagnosis" (confirmed and probable groups) as the reference standard, in which 26% (n=30) were diagnosed as extra-pulmonary TB. Analysis by patient shows that the overall sensitivity and specificity of smear, LJ and MODS against "clinical diagnosis" was 8.8% and 100%, 38.9% and 100%, 46% and 99.5% respectively with MODS significantly more sensitive than LJ culture (P=0.02). When analyzed by sample type, the sensitivity of MODS was significantly higher than LJ for gastric aspirates (P=0.004). The time to detection was also significantly shorter for MODS than LJ (7 days versus 32 days, P<0.001).
  
  
  CONCLUSIONS
  MODS [corrected] is a sensitive and rapid culture technique for detecting TB in children. As MODS culture can be performed at a BSL2 facility and is inexpensive, it can therefore be recommended as a routine test for children with symptoms suggestive of TB in resource-limited settings.
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam ; Oxford University Clinical Research Unit, Hanoi, Vietnam.
authors.forename: Sinh Thi
authors.initials: ST
authors.lastname: Tran
authors.forename: John Patrick
authors.initials: JP
authors.lastname: Renschler
authors.forename: Hai Thanh
authors.initials: HT
authors.lastname: Le
authors.forename: Hang Thi Thu
authors.initials: HT
authors.lastname: Dang
authors.forename: Tuan Minh
authors.initials: TM
authors.lastname: Dao
authors.forename: An Nhat
authors.initials: AN
authors.lastname: Pham
authors.forename: Liem Thanh
authors.initials: LT
authors.lastname: Nguyen
authors.forename: Hung
authors.initials: H
authors.lastname: Van Nguyen
authors.forename: Thuy
authors.initials: T
authors.lastname: Thi Thu Nguyen
authors.forename: Sy
authors.initials: S
authors.lastname: Ngoc Le
authors.forename: Annette
authors.initials: A
authors.lastname: Fox
authors.forename: Maxine
authors.initials: M
authors.lastname: Caws
authors.forename: Nhu
authors.initials: N
authors.lastname: Thi  Quynh Nguyen
authors.forename: Nhudo
authors.initials: N
authors.lastname: Thi Quynh
authors.forename: Peter
authors.initials: P
authors.lastname: Horby
authors.forename: Heiman
authors.initials: H
authors.lastname: Wertheim
mesh_terms: D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis; D014744:Vietnam
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