Challenges in diagnosing tuberculosis in children: a comparative study from Sudan

The extent of tuberculosis (TB) in children has not been completely established. According to the World Health Organization (WHO), the incidence of childhood TB is half a million cases with 74 000 deaths annually. 1 It has been argued that due to the challenges faced in the diagnosis of TB in childhood, the real burden of TB in children is higher. These challenges include the definition of a TB case as per the WHO (which requires a positive sputum smear), the varied and vague clinical presentation of TB in this age group, and the dereliction of national tuberculosis control programs in reporting child TB cases. Children commonly have a poor bacillary count, and many are negative on culture, 2 as these yield Mycobacterium tuberculosis in about 50% of cases at best. art from microbiological culture, alternative methodological approaches have been recommended to overcome the limitations faced in the diagnosis of childhood TB. he TB burden in Sudan is high. In 2009, the prevalence per 100 000 persons was 209, with an incidence of 50 000 cases. 8 Knowledge of many aspects of TB, especially childhood TB, is still lacking. A report in the recent literature has indicated that latent TB infection could be better diagnosed in household contacts and community controls using interferon-gamma release assays than with the tuberculin skin test (TST). In a cross-sectional study in Gezira, Sudan, it was found that the risk factors for being a patient with low access to pulmonary TB care included poverty, urbanization, a low level of education, and/or being idle. 10 Drug resistance in M. tuberculosis was found to be high (30%) in Kassala State and was found to be due predominantly to mutations in the rpoB gene. 11