PEDIATRIC TUBERCULOSIS: DIAGNOSTIC CHALLENGES AND FUTURE STRATEGIES

Аннотация

This comprehensive review delves into the persistent diagnostic barriers inherent in pediatric tuberculosis (TB), especially in high-burden, resource-limited countries such as Uzbekistan. Highlighting the clinical ambiguity caused by paucibacillary disease and the difficulty in specimen collection, the review covers conventional methods—including clinical scoring, chest radiography, tuberculin skin test (TST), interferon-gamma release assays (IGRAs), GeneXpert MTB/RIF and Ultra—as well as innovative advances like stool-based assays, blood- based host-response tests (e.g., Xpert MTB‑HR), and AI-enhanced chest X-ray interpretation. We also discuss digital decision-support systems, active case-finding, and contact-tracing strategies. Country-specific data underscore significant underdiagnosis, with up to 58% of cases missed in children aged 0–4 . The review advocates for integrated diagnostic algorithms supported by modern tools and stronger health systems, with research priorities focused on cost- effectiveness, technology adaptation, and tailored pediatric solutions. Keywords: pediatric tuberculosis, paucibacillary, GeneXpert MTB/RIF Ultra,Xpert MTB-HR host-response, stool‑based Xpert, AI‑based chest X‑ray, clinical scoring algorithms ,active case finding.,digital decision support, Uzbekistan burden Introduction:Tuberculosis in children remains a leading cause of mortality, with approximately 1.2 million pediatric cases and 226,000 deaths globally in 2023 . Paucibacillary infection, non- specific symptoms like fever and cough, and limited laboratory capacity make diagnosis challenging . In Uzbekistan (~57/100 000 incidence; ~3,200 pediatric cases in 2020), high MDR‑TB prevalence exacerbates detection issues . Underdetection is especially acute in children under 5,accounting for ~58% ofmissedcases . http://www.internationaljournal.co.in/index.php/jasass 567 Volume 15Issue 06, June 2025 Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023: 6.995, 2024 7.75 2.Methods Literature search: PubMed, WHO, MDPI, Scopus, Google Scholar, ResearchGate; English- language studies from the past decade, focusing on pediatric TB diagnosis in resource-limited settings. Inclusion criteria: Diagnostic performance, field implementation, technological innovations, modelingof missed cases. Datatriangulation: Supplemented byWHOreports and country-specific program data.