Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Euro Surveill. 2014 Mar 20;19(11):20744. doi: 10.2807/1560-7917.es2014.19.11.20744.
Laboratory confirmation of paediatric tuberculosis (TB) is frequently lacking. We reviewed the range of routine laboratory tests and their performance in different biological samples used to diagnose active TB in children. A questionnaire-based survey was conducted among the European Reference Laboratory Network for TB followed by collection of routine laboratory data on 10,549 paediatric samples tested in 2007 to 2011 at six reference laboratories (in Croatia, Germany, Italy, Latvia, Lithuania and the United Kingdom (UK)). The questionnaire showed that all laboratories used rapid assays. Non-respiratory samples were collected more often in Germany (135/275, 49.1%) and the UK (490/2,140, 22.9%) compared with Croatia (138/2,792, 4.9%), Latvia (222/2,401, 9.2%) and Lithuania (76/1,549, 4.9%). Overall laboratory positivity rates (isolation of Mycobacterium tuberculosis complex and/or identification of its nucleic acids in a sample) were higher in lymph node and gastric aspirate samples (14/203 (6.9%) and 43/1,231 (3.5%)) than in sputum samples (89/4,684 (1.9%)). Pooled sensitivity, specificity, positive and negative predictive values and accuracy of molecular assays assessed against solid or liquid culture were 79.2%, 93.6%, 67.1%, 96.5% and 91.6%, respectively. A more intensive approach in obtaining gastric aspirate and non-respiratory samples may increase laboratory confirmation of paediatric TB. Major effort is needed in optimisation and validation of molecular tests in these samples.
儿科结核病（TB）的实验室确诊常常不足。我们回顾了常规实验室检测的范围及其在用于诊断儿童活动性 TB 的不同生物样本中的表现。我们对欧洲结核病参考实验室网络进行了一项基于问卷的调查，随后收集了 2007 年至 2011 年在六个参考实验室（克罗地亚、德国、意大利、拉脱维亚、立陶宛和英国）检测的 10549 例儿科样本的常规实验室数据。问卷显示，所有实验室均使用快速检测方法。与克罗地亚（138/2792，4.9%）、拉脱维亚（222/2401，9.2%）和立陶宛（76/1549，4.9%）相比，德国（135/275，49.1%）和英国（490/2140，22.9%）更常采集非呼吸道样本。总体而言，淋巴结和胃液样本的实验室阳性率（分离结核分枝杆菌复合体和/或在样本中鉴定其核酸）高于痰样本（203 例中的 14 例[6.9%]和 1231 例中的 43 例[3.5%]，4684 例中的 89 例[1.9%]）。针对固体或液体培养物评估的分子检测的汇总敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 79.2%、93.6%、67.1%、96.5%和 91.6%。更积极地获取胃液和非呼吸道样本可能会增加儿科结核病的实验室确诊。需要在这些样本中优化和验证分子检测方法，并为此付出巨大努力。
