Editorial Commentary: Improving Children's Access to New Tuberculosis Diagnostic Tools Starts With the Collection of Appropriate Specimens

(See the Major Article by Marcy et al on pages 1161–8.) Bacteriological confirmation of tuberculosis in children is the endpoint in a cascade of events that is riddled with true and perceived obstacles. A critical barrier is the collection of adequate specimens for diagnostic investigation. In many settings where the tuberculosis burden is high, there is a discrepancy between the access to tuberculosis diagnostic tools and the capacity to obtain appropriate clinical specimens in children, especially young ones. This discrepancy is likely more pronounced in primary care settings, where human resources, capacity, and equipment are frequently scarce. The PAANTHER study, presented by Marcy and colleagues in this issue of Clinical Infectious Diseases, has made some headway toward bridging this gap. Their results are very welcome and timely, given the rising awareness and importance given to the global plight of childhood tuberculosis and the fact that there is now an opportunity for change of practice. Increased efforts to develop training, build capacity, and decentralize services for prevention, diagnosis, and care for children affected by tuberculosis are under way. At the same time, new and improved diagnostic tools such as the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay (Xpert; Cepheid, Sunnyvale, California) are being scaled up and becoming available at lower levels of care, and there is ongoing research to optimize the accuracy of Xpert and to develop improved tools that can be used closer to the point of care.