Improving the diagnosis of pulmonary tuberculosis using line probe assay and determining the factors associated with the disease in children in Jos, Nigeria

Augustine O Ebonyi; Stephen Oguche; Ibrahim I Abok; Yetunde O Isa; Charles C Ani; Helen O Akhiwu; Marcia M Ihekaike; Esther S Yiltok; Martha O Ochoga; Atiene S Sagay

doi:10.18683/germs.2020.1225

Improving the diagnosis of pulmonary tuberculosis using line probe assay and determining the factors associated with the disease in children in Jos, Nigeria

Germs. 2020 Dec 28;10(4):328-337. doi: 10.18683/germs.2020.1225. eCollection 2020 Dec.

Authors

Affiliations

¹ MBBS, MSc, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
² BMBCh, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
³ MBBS, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
⁴ BMLS, MSc, MPH, APIN Laboratory, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
⁵ MBBS, Department of Radiology, University of Jos and Department of Radiology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
⁶ MBBS, Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
⁷ MBBS, Faith Alive Foundation Hospital, P. O. Box 745, Jos, Nigeria.
⁸ MBBS, MEd, Department of Paediatrics, University of Jos and Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
⁹ BMBCH, Department of Paediatrics, Benue State University, PMB 102119, Makurdi, Nigeria.
¹⁰ BSc, MBChB, Department of Obstetrics and Gynaecology, University of Jos and Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.

Abstract

Introduction: Diagnosing tuberculosis (TB), including pulmonary tuberculosis (PTB), in children remains a challenge, partly due to its paucibacillary nature in young children. Data on the use of line probe assay (LPA), on gastric and sputum samples, for diagnosing PTB in children are scarce. We determined the proportion of samples positive for Mycobacterium tuberculosis (MTB) by smear microscopy (SM) and LPA in presumptive PTB cases as well as the factors associated with PTB confirmed by LPA, in children in Jos, Nigeria.

Methods: An observational study in children aged 6 months-16 years. Gastric and sputum samples were examined by SM and by LPA for MTB using GenoType MTBDRplus Ver 2.0 (Hain Lifescience). Multivariate logistic regression was performed to determine the factors associated with PTB.

Results: Out of 103 children with presumptive PTB, 47 had confirmed PTB, 26 unconfirmed PTB and 30 unlikely PTB by LPA. In 67 gastric samples, MTB was identified by SM in 2 (3.0%) compared to 28 (41.8%) by LPA while in 31 sputum samples, MTB was identified by SM in 5 (16.1%) compared to 18 (58.1%) by LPA. The factors associated with pulmonary tuberculosis were an abnormal chest X-ray (adjusted odds ratio (AOR))=12.39 [3.75-40.90], p<0.001), sleeping in the same room with more than three persons (AOR=3.30 [1.23-8.85], p=0.018) and sleeping in a room with none or one window (AOR=2.86 [1.03-7.95], p=0.044).

Conclusions: Line probe assay improves the diagnosis of pulmonary TB in children, especially with gastric samples, while an abnormal chest X-ray is a useful adjunct in PTB diagnosis. Avoiding overcrowding and having windows in sleeping rooms are a necessary part of TB prevention.

Keywords: Line probe assay; chest X-ray; children; gastric sample; pulmonary tuberculosis; smear microscopy; sputum sample.

GERMS.