Diagnosis of Childhood Tuberculosis and Host RNA Expression in Africa

• Published in: The New England journal of medicine Vol. 370; no. 18; pp. 1712 - 1723
• Main Authors: Anderson, Suzanne T, Kaforou, Myrsini, Brent, Andrew J, Wright, Victoria J, Banwell, Claire M, Chagaluka, George, Crampin, Amelia C, Dockrell, Hazel M, French, Neil, Hamilton, Melissa S, Hibberd, Martin L, Kern, Florian, Langford, Paul R, Ling, Ling, Mlotha, Rachel, Ottenhoff, Tom H.M, Pienaar, Sandy, Pillay, Vashini, Scott, J. Anthony G, Twahir, Hemed, Wilkinson, Robert J, Coin, Lachlan J, Heyderman, Robert S, Levin, Michael, Eley, Brian
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 01.05.2014
• Subjects: Africa; Algorithms; Bacterial diseases; Bacteriological Techniques; Biological and medical sciences; Child; Child, Preschool; Childhood; Children; Children & youth; Deoxyribonucleic acid; Diagnosis; Diagnosis, Differential; DNA; General aspects; HIV; HIV Infections - complications; Human bacterial diseases; Human immunodeficiency virus; Humans; Infant; Infectious diseases; Latent Tuberculosis - diagnosis; Male; Medical diagnosis; Medical sciences; Mycobacterium tuberculosis - genetics; Mycobacterium tuberculosis - isolation & purification; Oligonucleotide Array Sequence Analysis; Population studies; Ribonucleic acid; Risk; RNA; RNA, Bacterial - blood; Sensitivity and Specificity; Transcription; Transcriptome; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - genetics; Tuberculosis and atypical mycobacterial infections; Africa; Human; Infection; Medicine; Tuberculosis; RNA; Bacteriosis; Mycobacterial infection; Diagnosis; Child
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1303657

Diagnosing active tuberculosis remains a challenge, especially in children. In this study, which included HIV-negative and HIV-positive children, a 51-transcript signature for active tuberculosis was evaluated as a potential diagnostic tool. Between 500,000 and 1 million new cases of childhood tuberculosis are diagnosed annually, but the true global burden of childhood tuberculosis is unknown because it is often difficult to confirm the diagnosis microbiologically. 1 – 3 Although most cases of tuberculosis in adults are diagnosed through detection of acid-fast bacilli on microscopic examination of a sputum specimen, in the majority of childhood cases, smears and cultures are negative for Mycobacterium tuberculosis, and the diagnosis is made solely on clinical grounds. 1 , 3 Since the symptoms and signs of childhood tuberculosis are seen in a range of other conditions, clinical diagnosis is unreliable. 4 Clinical . . .