Nusrat Buzdar, Abu Talib, Fauzia Zafar, Nadir Bashir.
Frequency of Pulmonary Tuberculosis in Clinically Suspected Cases Using PCR on Sputum .
Pak Paed J Jan ;41(2):84-90.

Objectives: To determine the frequency of pulmonary tuberculosis in clinically suspected cases in children aged from 6-13 years using PCR on sputum visiting a tertiary care hospital. Study Design: Descriptive Cross sectional. Place of Study: Department of Pediatric Medicine Nishtar Hospital, Multan. Duration of Study: Six months from 29th December 2012 to 28th June 2013. Methodology: 142 consecutive patients ranging in age from 6 – 13 years with clinically suspected pulmonary tuberculosis were investigated after admitting them in The Department of Pediatric Medicine Nishtar Hospital, Multan. Permission was taken from ethical committee before starting study. Written informed consent was taken from the parents of the children. Patients were selected from outdoor as well as indoor Nishtar Hospital, Multan after detailed history and physical examination. X-ray chest was performed in all the patients. As per protocol, 2-10 mL of early morning sputum specimen was collected in a sterile, wide mouth leak-proof container. Three consecutive specimens of sputum were analyzed by ZN staining and microscopy from central laboratory of the hospital and the report will be interpreted as positive or negative for mycobacteria. All the patients with sputum smear positive were analyzed by PCR test on sputum samples for presence or absence of MTB-DNA from central laboratory of the hospital on sputum collected in same way as for sputum smear. All the data was entered in a pre-designed proforma. Results: Statistical analysis was performed by entering all the data in SPSS version 10. There were 142 patients in total. Males were 77 (54.2%) while females were 65 (45.8%). Mean age of the patients was 9.75 + 2.27 years. Mean weight of the patients was 23.80 + 4.1. Among whole of the patient population 32 (22.5%) were not properly vaccinated according to the EPI schedule. Sputum for MTB PCR was found to be positive in 42 (29.6%) patients. When the effect of gender was noted on the frequency of sputum PCR positivity it was found that 26 (33.8%) males while 16 (24.6%) females had PCR positive (p-value=0.234). When the effect of age was noted it was found that 20 (30.3%) in age group 6-9 years while 22 (28.9%) in age group 10-13 years were sputum PCR positive (p-value = 0.156). When the effect of weight was seen it was found that 23 (28.8%) in weight group < 25 while 19 (30.6%) had sputum PCR positive (P-value=0.806). When the effect of immunization status was noted it was found that among those with no proper vaccination 6 (18.75%) turned out to be positive for tuberculosis and among those with proper vaccination tuberculosis was present in 36 (32.7%) (P-value = 0.115). Conclusion: A significant proportion of clinically suspected cases of tuberculosis disease do not suffer from the disease, and microbiological confirmation must be sought to confirm the clinical suspicion preferably through the use of PCR based assays.

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