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Recent advances in the diagnosis of childhood tuberculosis
  1. Ben J Marais1,
  2. Madhukar Pai2
  1. 1Ukwanda Centre for Rural Health and the Department of paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada
  1. Correspondence to:
    Dr B J Marais
    Ukwanda Centre for Rural Health and the Department of Paediatirics and Child Health, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, Cape Town 7505, South Africa;bjmarais{at}


Children account for a major proportion of the global tuberculosis disease burden, especially in endemic areas. However, the accurate diagnosis of childhood tuberculosis remains a major challenge. This review provides an overview of the most important recent advances in the diagnosis of intrathoracic childhood tuberculosis: (1) symptom-based approaches, including symptom-based screening of exposed children and symptom-based diagnosis of active disease; (2) novel immune-based approaches, including T cell assays and novel antigen-based tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for tuberculosis diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active tuberculosis in children, but establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge, particularly in high-burden settings. Although improved access to diagnosis and treatment is essential, ultimately the burden of childhood tuberculosis is determined by the level of epidemic control achieved in a particular community. Several recent initiatives, in particular the United Nations Millennium Developmental Goals, deal with the problem of poverty and disease in a holistic fashion, but global political commitment is required to support these key initiatives.

  • CXR, chest x ray
  • ELISPOT, enzyme-linked immunospot
  • FDA, Food and Drug Administration
  • LTBI, latent tuberculosis infection
  • MODS, microscopic observation drug susceptibility assay
  • NTM, non-tuberculous mycobacteria
  • TST, positive tuberculin skin test
  • WHO, World Health Organization

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  • Competing interests: None.

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