There is an urgent need for improved TB diagnostics in children, since current diagnostics are not taking into account the specific challenges of childhood TB. New diagnostic tools have been developed and endorsed by the World Health Organization, such as LED microscopy, line probe assays and Xpert MTB/RIF, but their applicability to childhood TB has rarely been evaluated due to the difficulty of clearly diagnosing and defining these cases. Tools specifically developed for childhood TB are needed.
In order to provide a way forward and reach consensus on how to address diagnosis of childhood TB in a research setting, the US National Institutes of Health organised a workshop in 2011 on 'Critical Issues in Pediatric Tuberculosis Diagnostics Research in HIV-Infected and Uninfected Children', which brought together expert clinicians, researchers and other leaders in childhood TB. The results of this consensus process have now been published as two papers in a special supplement 'Tuberculosis, Tuberculosis/HIV: Unanswered Questions and Controversies' by the Journal of Infectious Diseases.
Union consultant Dr Steve Graham is the lead author of the first publication, which proposes clinical case definitions for intrathoracic TB in children. These definitions will enable the inclusion of children with suspected TB in research studies, even if they are missing bacteriological confirmation.
The second publication deals with methodological issues when including children in diagnostics research, such as enrollment criteria, age categories, reference standards and standard operating procedures. It also suggests ways to report research results in a standardised manner.
The use of consensus case definitions as well as a standardised way of reporting research results will make these results comparable and enable the quality assessment of new diagnostic tools in children.
The suggested definitions and approaches should be widely adopted and bring an end to the longtime excuse that childhood TB is too complicated to include in diagnostic studies.
From now on, children should become a priority in the development and assessment of new TB diagnostics.