The Quest for a Child-Friendly Tuberculosis Triage Test

The lack of diagnostic assays for children with tuberculosis (TB) represents one of the weakest links in the TB continuum of care. Globally, the most widely used tests to confirm TB involve obtaining a respiratory specimen for the microbiologic detection of Mycobacterium tuberculosis complex. While there is still reliance on smear microscopy, tremendous efforts have been made to increase usage of World Health Organization (WHO)-approved rapid molecular methods such as the GeneXpert MTB/RIF assay. Recommendations for using such assays as a first-line test extend to pediatric populations; however, it is important to recognize the associated logistic barriers and performance pitfalls that limit their usefulness. In settings with a high prevalence of TB, rapid molecular tests are not commonly available at lower-level health facilities due to cost and infrastructure limitations, among others [1]. When accessible, microbiologic assays have reduced yield among children, in whom disease is characterized by a lower mycobacterial load. Furthermore, obtaining a good quality respiratory specimen for testing could require semi-invasive techniques which may not be manageable in all clinical settings.