Ten years Trend in Pediatric Tuberculosis Diagnosis in a South Indian State Under Programmatic Setting
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SCIENTIFIC LETTER
Ten years Trend in Pediatric Tuberculosis Diagnosis in a South Indian State Under Programmatic Setting Ariarathinam Newtonraj 1
&
Anil Jacob Purty 1 & Murugan Natesan 1 & Mani Manikandan 1
Received: 4 April 2020 / Accepted: 7 July 2020 # Dr. K C Chaudhuri Foundation 2020
To the Editor: India is striving hard towards the elimination of Tuberculosis (TB) by 2025, with the introduction of New National Tuberculosis Elimination Programme (NTEP) [1]. One of the main challenge in the public health is early diagnosis and treatment of Pediatric TB (PedTB). Difficulty in quality sample collection and availability of modern diagnostic tests makes the PedTB diagnosis difficult [2]. Understanding this, in public health, modern diagnostic tests were introduced in a South Indian State for the past one decade [2012 – Liquid culture, Line Probe Assay (LPA), 2017 – Cartridge based Nucleic Acid Amplification Test (CbNAAT)], to increase the microbiological confirmation of PedTB. We analysed the PedTB case notification trends from 2010 to 2019 in this state under programmatic setting after getting administrative and institutional ethics committee (IEC) approvals. As the total (Adult+Pediatric) TB notification remained same from 2010 to 2019 (1437, 1568, 1430, 1458, 1409, 1288, 1412, 1346, 1455, 1477 respectively), it was expected that total Pediatric TB notification will also remain same and microbiologically confirmed Pulmonary PedTB (PulPedTB) will increase due to modern diagnostic tools and the clinically confirmed PulPedTB will decrease. But our major finding was, microbiologically confirmed PulPedTB notification didn’t show any increase (1, 7, 4, 7, 7, 6, 5, 2, 10, 12 respectively from 2010 to 2019), but there was a drastic decline in clinically diagnosed (microbiologically negative) PulPedTB notification (109, 84, 49, 43, 27, 20, 21, 10, 9, 8 respectively from 2010 to 2019) and also total PedTB notification (156, 130, 88, 91, 72, 54, 60, 30, 55, 50 respectively from 2010 to 2019) and there was a moderate decline in Pediatric extrapulmonary tuberculosis (PedEPTB)
* Ariarathinam Newtonraj [email protected] 1
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
notification (46, 39, 35, 41, 38, 28, 34, 18, 36, 30 respectively from 2010 to 2019). Reasons for this decline in notification may be newer diagnostic tools might have decreased the clinically diagnosed cases, but didn’t increase the microbiological confirmation. Meanwhile, CbNAAT is faster in diagnosis but CbNAATnegative should be interpreted cautiously because its sensitivity depends on the quality of sample and the site of sample collection and should not be considered as a gold standard. NTEP stresses that the treating physician should try all the possible diagnostic modalities to microbiologically confirm the suspected pediatric case before exclusion, and at the end experts have the liberty to diagnose as clinically confirmed Pulmonary PedTB [3, 4]. To conclude, there is a dearth of information on the
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