Culture is an imperfect and heterogeneous reference standard in pediatric tuberculosis

In pediatric tuberculosis (pTB), culture is the accepted reference standard for assessing new diagnostic tests despite culture only confirming 10–50% of clinically diagnosed cases. Using the studies previously included in the systematic review of Gene Xpert, we evaluated the diagnostic yield of cult...

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Bibliographic Details
Published in:Tuberculosis (Edinburgh, Scotland) Scotland), 2016-12, Vol.101, p.S105-S108
Main Authors: DiNardo, Andrew R, Detjen, Anne, Ustero, Pilar, Ngo, Katherine, Bacha, Jason, Mandalakas, Anna M
Format: Article
Language:English
Subjects:
Adolescent
Age of Onset
Antitubercular Agents - therapeutic use
Bacteriological Techniques - standards
Calibration
Child
Child, Preschool
Culture
Diagnosis
Humans
Infectious Disease
Molecular Diagnostic Techniques - standards
Mycobacterium tuberculosis - genetics
Mycobacterium tuberculosis - isolation & purification
Predictive Value of Tests
Prognosis
Pulmonary/Respiratory
Reference standard
Reference Standards
Reproducibility of Results
Sputum - microbiology
Time Factors
Tuberculosis
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - microbiology
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Summary:In pediatric tuberculosis (pTB), culture is the accepted reference standard for assessing new diagnostic tests despite culture only confirming 10–50% of clinically diagnosed cases. Using the studies previously included in the systematic review of Gene Xpert, we evaluated the diagnostic yield of culture. Children with symptoms and signs suggestive of TB were considered to have a clinical diagnosis if they were 1) culture positive or 2) followed clinically for at least one month and started on Anti-Tuberculosis Therapy (ATT). Of 1989 children with presumptive pTB, 229 (11.5%) had culture-confirmation. Of the remaining 1760 culture negative children, 710 (24.4) were classified as culture-negative clinical TB and 821 were classified as “not TB”. Diagnostic yield of culture was 24.4% (median 28.7% IQR 15.6%–42.4%; range 1.5%–65%). Culture, the accepted reference standard for pediatric TB diagnostics, has a low and variable yield that impacts how diagnostic studies should be reported as well as everyday clinical care.
ISSN:1472-9792
1873-281X
DOI:10.1016/j.tube.2016.09.021