Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 10:12:1370687.
doi: 10.3389/fped.2024.1370687. eCollection 2024.

Paediatric pulmonary disease-are we diagnosing it right?

Priya Rajendran  1 , Silla Varghese Thomas  1 , Sarath Balaji  2 , Elilarasi Selladurai  2 , Ganesh Jayachandran  3 , Aravind Malayappan  3 , Adhin Bhaskar  1 , Sivaraman Palanisamy  1 , Thirumalani Ramamoorthy  1 , Sindhu Hasini  1 , Syed Hissar  1
Affiliations

Paediatric pulmonary disease-are we diagnosing it right?

Priya Rajendran et al. Front Pediatr. .

Abstract

Background: It has been reported that differential diagnosis of bacterial or viral pneumonia and tuberculosis (TB) in infants and young children is complex. This could be due to the difficulty in microbiological confirmation in this age group. In this study, we aimed to assess the utility of a real-time multiplex PCR for diagnosis of respiratory pathogens in children with pulmonary TB.

Methods: A total of 185 respiratory samples [bronchoalveolar lavage (15), gastric aspirates (98), induced sputum (21), and sputum (51)] from children aged 3-12 years, attending tertiary care hospitals, Chennai, India, were included in the study. The samples were processed by N acetyl L cysteine (NALC) NAOH treatment and subjected to microbiological investigations for Mycobacterium tuberculosis (MTB) diagnosis that involved smear microscopy, Xpert® MTB/RIF testing, and liquid culture. In addition, DNA extraction from the processed sputum was carried out and was subjected to a multiplex real-time PCR comprising a panel of bacterial and fungal pathogens.

Results: Out of the 185 samples tested, a total of 20 samples were positive for MTB by either one or more identification methods (smear, culture, and GeneXpert). Out of these 20 MTB-positive samples, 15 were positive for one or more bacterial or fungal pathogens, with different cycle threshold values. Among patients with negative MTB test results (n = 165), 145 (87%) tested positive for one or more than one bacterial or fungal pathogens.

Conclusion: The results suggest that tuberculosis could coexist with other respiratory pathogens causing pneumonia. However, a large-scale prospective study from different geographical settings that uses such simultaneous detection methods for diagnosis of childhood tuberculosis and pneumonia will help in assessing the utility of these tests in rapid diagnosis of respiratory infections.

Keywords: children; coinfection; diagnosis; multiplex real-time PCR; pneumonia; tuberculosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients included in different groups.
Figure 2
Figure 2
Distribution of bacterial pathogens among MTB positives in the TB group.
Figure 3
Figure 3
Distribution of bacterial pathogens causing pneumonia in the MTB-negative TB group (n = 90).
Figure 4
Figure 4
Distribution of bacterial pathogens causing pneumonia in the MTB-negative pneumonia group (n = 55).
See this image and copyright information in PMC

References

    1. WHO Consolidated Guidelines on TB. Module 5: Management of TB in Children and Adolescents. Geneva: World Health Organization; (2022). - PubMed
    1. GBDLRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. (2018) 18(11):1191–210. 10.1016/S1473-3099(18)30310-4 - DOI - PMC - PubMed
    1. GBDDD Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. (2018) 18(11):1211–28. 10.1016/S1473-3099(18)30362-1 - DOI - PMC - PubMed
    1. Sonego M, Pellegrin MC, Becker G, Lazzerini M. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One. (2015) 10(1):e0116380. 10.1371/journal.pone.0116380 - DOI - PMC - PubMed
    1. Wei M, Yongjie Z, Zhuoyu Q, Biao Y, Xi J, Wei J, et al. Pneumonia caused by Mycobacterium TB. Microbes Infect. (2020) 22(6–7):278–84. 10.1016/j.micinf.2020.05.020 - DOI - PMC - PubMed

LinkOut - more resources