History: The diagnosis of childhood tuberculosis (TB) can be difficult in severely malnourished children. compared the sensitivity, specificity, positive, and negative predictive values, and accuracy of modified Kenneth Jones criteria (MKJC) score, World Health Organization (WHO) criteria, and ALS in diagnosing TB in severely malnourished children with pneumonia for Confirmed TB and All TB (Confirmed TB plus Probable TB) vs. Not TB. Results: Compared to culture confirmed TB, the sensitivity, and specificity (95% CI) for MKJC were 60 (27C86) and 84 (79C87)% and for WHO criteria were 40 (14C73) and 84 (80C87)%, respectively. Compared to culture and/or Xpert MTB/RIF positive TB, the sensitivity and specificity (95% CI) for the criteria were 37 (20C58) and 84 (79C87)%; and 22 (9C43) and 83 (79C87)%, respectively. For both these comparisons, the sensitivity and specificity of ALS were 50 (14C86) and 60 (53C67)%, respectively. Conclusion: Our data suggest that WHO criteria and MKJC scoring mainly based on clinical criteria are more useful than ALS in diagnosing TB in young severely malnourished children with pneumonia. The results underscore the importance of using clinical criteria for the diagnosis of TB in seriously malnourished kids that might help to minimize the opportunity of over treatment with anti-TB in such human population, in source small TB endemic configurations especially. takes so long as 8C12 weeks. Latest question of TB diagnostics, real-time PCR by Xpert MTB/RIF which just requires 2 h to supply results, is costly and offers poorer level of sensitivity in kids (3) in comparison to adults (4). Nevertheless, in both diagnostics, assortment of high quality test is imperative. Test from ill malnourished kids needs at least 3C4 h fasting with cautious monitoring. With this contexts, revised Kenneth Jones requirements (MKJC) rating (5), and Globe Health Corporation (WHO) requirements (6) for years as a child TB analysis, both which mainly predicated on basic medical data to look for the likelihood a kid has tuberculosis together with response to therapy and dietary status (7), may have higher value in configurations where microscopy can be adverse or Xpert MTB/RIF has gone out of reach. Lately, antibodies in lymphocyte supernatant (ALS) continues to be reported to correlate with medical diagnoses of TB in adults (8, 9) and kids (10), nonetheless it do not succeed when it had been weighed against microbiologically confirmed years as a child TB in seriously malnourished kids (11). With this background, the purpose of this evaluation was to GYKI-52466 dihydrochloride judge the relative performance of MKJC score, WHO criteria, and ALS in the diagnosis of childhood TB in comparison with culture and Xpert MTB/RIF. Materials and Methods Ethics Statement The study (protocol number: PR-10067) was approved by the Research Review Committee (RRC) and the Ethical Review Committee (ERC) of icddr,b. Written informed consent was obtained from parents or guardians of each of the participating children; children whose caregivers did not give consent were not enrolled. Study Design The information of study population, study settings, study sample, and patient management has been described in a recently published study (11). The sample for ALS was taken from blood of the study population in addition to gastric lavage fluid and induced sputum for microscopy, mycobacterial culture, and real-time PCR by Xpert MTB/RIF. Using culture and/or Xpert MTB/RIF positivity as the reference, we compared the sensitivity, specificity, positive, and negative predictive values, and accuracy of modified Kenneth Jones criteria (MKJC) (5), and World Health Organization (WHO) criteria (6), and GYKI-52466 dihydrochloride ALS for the GYKI-52466 dihydrochloride diagnosis of TB in severely malnourished children presenting with pneumonia. Laboratory procedure for ALS has been described earlier by Raqib et al. (10). Briefly, for ALS assay 3.0 ml blood was taken from the patient with adequate precaution and peripheral blood mononuclear cells (PBMC) were separated from plasma by Ficoll-hypaque density gradient centrifugation, after washing, PBMC were cultured in tissue-culture medium without any stimulation for 48 h. Cell culture supernantant was Rabbit Polyclonal to GPRIN3 collected and BCG-specific IgG antibodies were measured by ELISA. ALS positive [optical density (OD) 0.35] and ALS borderline positive (OD = 0.34) were categorized according to ALS cut-off for OD following basic principle described elsewhere (10). Measurements Case report forms (CRF) were developed for collection of relevant data, and finalized after pre-testing. Characteristics analyzed include ALS, WHO criteria, and MKJC score. Analysis All data were entered into a computer using SPSS for Windows (version 15.0; SPSS Inc., Chicago) and Epi-Info (version 6.0, USD, Stone Mountain, GA). Level of sensitivity, specificity, positive, and adverse predictive ideals, and accuracy using their 95% self-confidence intervals (CIs) for.
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