Clinicomicrobiological Profile and Diagnostic Utility of Xpert Mycobacterium Tuberculosis/Rifampicin in Pediatric Tuberculosis: An Observational Study

Objectives: To study the clinicomicrobiological profile and evaluate cartridge-based nucleic acid amplification test (CBNAAT) positivity in presumptive pulmonary and extrapulmonary tuberculosis (EPTB) in pediatric patients.Materials and methods: It was a descriptive observational study done in pediatric presumptive pulmonary tuberculosis (PTB) and EPTB patients in a tertiary care institute of northern India.Pulmonary as well as extrapulmonary samples were collected as per clinical signs and symptoms and subjected to Ziehl-Neelsen (ZN) staining, Xpert MTB/RIF, and Lowenstein-Jensen (LJ) culture simultaneously.Results: Total 100 children were enrolled during the study period.About 57 children were diagnosed with tuberculosis (TB) during the study period.PTB, EPTB, and disseminated TB were detected in 26, 21, and 10 patients, respectively.The male to female ratio was 1:1.4,with a slight female preponderance.The most common presenting symptoms were fever (88%), cough (63%), and weight loss (38%).In the EPTB group, 43% had pleural effusion, followed by central nervous system (CNS) TB and abdominal TB in 28 and 24%, respectively.Among the cohort of diagnosed patients, 50.87% of cases were confirmed microbiologically, and 49.13% were confirmed clinically.The sensitivity and specificity of CBNAAT were revealed to be 90.91%(95% CI: 70.84-98.88%)and 88.46% (95% CI: 79.22-94.59%),respectively.The sensitivity and specificity of CBNAAT in PTB were 91.67 and 66.67%, and in EPTB, they were 50 and 100%, respectively.No rifampicin resistance was detected among diagnosed cases.Conclusion: Detailed history and examination are required for diagnosing TB in the pediatric population.GeneXpert is a high-utility tool that provides rapid diagnosis and information on rifampicin resistance in the pediatric population.Hence, it helps in the early initiation of therapy in children.