ArticleThe Pediatric infectious disease journal2026
Optimizing Diagnostic Protocols for Pulmonary Tuberculosis in Children: A Comparison of Diagnostic Yields From One-day, Two-day and Three-day Specimen Collection Strategies.
Article in The Pediatric infectious disease journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiagnosing pediatric pulmonary tuberculosis (PTB) remains challenging due to low bacterial load and difficulty obtaining specimens. Current guidelines recommend 3-day acid-fast bacilli (AFB) and culture, with 1 molecular testing. We aimed to compare diagnostic yield across 1-, 2- and 3-day collection protocols.
methodsWe conducted a retrospective study of children <18 years with PTB at a tertiary hospital (2015-2023) who submitted 3 gastric aspirates (GA) or sputum specimens. Patients without molecular results, treated >14 days, or non-tuberculous mycobacterial infections were excluded. Diagnostic sensitivity was calculated using the World Health Organization-defined Clinical Reference Standard as the reference comparator. Two diagnostic approaches were assessed: (1) AFB + nucleic acid amplification test (NAAT); (2) AFB + NAAT + culture.
resultsOf 244 children screened, 165 were included (112 GA, 53 sputum). Mean ages were 4.8 and 14.5 years, respectively. In GA, (1) AFB + NAAT showed an absolute increase of 5.4% (95% confidence interval: -5.5 to 16.2) from days 1 to 2 (cumulative yield: 25.0%) and 2.7% (-8.9 to 14.2) on day 3 (27.7%). (2) Adding culture improved yield by 3.6% (-9.2 to 16.4) on day 2 (42.0%) and 2.7% (-10.3 to 15.7) on day 3 (44.6%). In sputum, (1) AFB + NAAT showed a 1.9% (-16.8 to 20.6) increase on day 3 (from 58.5% to 60.4%). (2) With culture, yielded consistently 73.6% across all days (0%, -16.8 to 16.8).
conclusionsTwo-day specimen collection may be sufficient for PTB diagnosis. At least 1 culture should be included in the workup due to the highest sensitivity and ability to provide drug susceptibility information.
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