Diagnosis of DR-TB in Children

Presumptive Drug-resistant TB (DR-TB) in Children

It occurs mostly in children who:

• Are contacts of adults with Multidrug-resistant (MDR)/ DR-TB
• Are lost to follow-up after initiating treatment
• Present with recurrence of disease after previous treatment
• Do not respond to treatment with first-line drugs
• Are Children Living with HIV (CLHIV).

All efforts must be taken to ensure microbiological confirmation of DR-TB diagnosis among children through getting an appropriate body fluid sample for both pulmonary or extrapulmonary-TB cases.

Sputum (or other relevant samples, e.g., gastric aspirate, induced sputum, bronchoscopic lavage, lymph node aspiration, Cerebro Spinal Fluid (CSF), tissue biopsies) needs to be collected in all children with presumed DR-TB for diagnosis.

The diagnosis of DR-TB in children is done based on Nucleic Acid Amplification Test (NAAT) or Line Probe Assay (LPA) results. If these are invalid, Culture and Drug Susceptibility Testing (C&DST) will be carried out to establish the diagnosis.

In a presumptive DR-TB patient, if there is no bacteriological confirmation, bacteriologically negative clinically diagnosed probable DR-TB can be considered after ruling out alternative diagnosis.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, 2021.

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