Clinical profile of childhood tuberculosis and diagnostic efficacy of CBNAAT in tertiary care hospital.

Background: Tuberculosis is the major problem of public health with high morbidity and mortality, a continuing scourge of India. The DOTS strategy of the national program targeted on identifying and treating smear +ve cases, which focus on infectious cases and preventing the transmission. Thus the children are ignored as a hidden epidemic since smear-positive cases are focused on diagnosis which is much less in children when compared to adults, thus the prevalence and morbidity of disease in children is not available mainly from developed countries. Aim and objective: To study the clinical profile of childhood tuberculosis, to compare the efficacy of CBNAAT as a diagnosis tool between pulmonary and extrapulmonary TB. Materials and methods: In the prospective study, in the Department of Pediatrics and Chest Medicine in our tertiary care hospital, Salem in the year 2018 January to December. Informed consent was obtained from parents and caregivers before including the children in the study. There was no risk to the children due to the study. A data collection sheet (proforma) was filled for each child based on the inclusion criteria that were suspected presumptive TB after obtaining informed consent. Results: Among 100 samples collected, 69 children had extrapulmonary symptoms and signs; when compared to 31 had pulmonary symptoms and signs. Among 31 presumptive TB cases, the gold standard microbiologically confirmed TB was 2 as compared to 6 cases which were detected by CBNAAT results that were not detected by sputum examination. This was found to be statistically significant (P=0.017). Thus CBNAAT increases the detection rate of pulmonary TB thrice. Thus Sensitivity of the CBNAAT was 94%, Specificity was 86.67, PPV 33.33, NPV 95.12; Accuracy 73.33. This was highly significant at p<0.1. Among 100 presumptive TB cases, CBNAAT was positive in 10, it also detects cases that were negative by conventional laboratory methods. Conclusion: When compared to the efficacy of CBNAAT with gold standard microbiological confirmation, CBNAAT detects thrice the caseload in pulmonary TB in the community. Thereby increasing the case detection rate and preventing the complication. In the case of extrapulmonary TB, CBNAAT detects 30% of pathologically confirmed TB lymphadenitis and 33% CNS TB among pediatric TB. [ABSTRACT FROM AUTHOR]