Clinico-radiological criteria versus GeneXpert for diagnosis of pediatric tuberculosis


  • Saïd O. Ali Department of Pediatrics, Mother-Child University Hospital Tsaralalana, Antananarivo, Madagascar
  • Hanitriniaina S. C. Samena Department of Pediatrics, Mother-Child University Hospital Tsaralalana, Antananarivo, Madagascar
  • Kanto A. Razafindraibe Department of Medical Imaging, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
  • Annick L. Robinson Department of Pediatrics, Mother-Child University Hospital Tsaralalana, Antananarivo, Madagascar Faculty of Medicine, Antananarivo, Madagascar



Pediatric tuberculosis, Sensitivity and specificity, Scoring system, Thoracic radiography


Background: Diagnosing tuberculosis in children remains a challenge especially in low-income countries. The aim of this study was to assess the performance of the scoring system combined to chest x-ray images compared to GeneXpert for diagnosis of pediatric tuberculosis.

Methods: A retrospective diagnostic accuracy study was carried out on hospitalized children aged 0 to 14 years old, tuberculosis suspect in the pediatric department of the Tsaralalana mother child university hospital center from August 2018 to June 2020.

Results: Fifty-one medical files were retained. The mean age was 4±2 years old with a sex ratio of 1.55. The reason for consultation was dominated by respiratory signs (56.9%). The GeneXpert was positive in 58.9% of cases. The chest X-ray images were pathological in all cases, dominated by images of condensation or infiltration (72.5%). WHO score was positive (≥7) in 72.5% of cases. The clinico-radiological criteria had a sensitivity of 13.3-63.3%, a specificity of 61.9-95.2%, positive predictive values of 1.5-6.9% and negative predictive values of 98.8-99.3%.

Conclusion: Clinico-radiological criteria could be useful in individual diagnosis of pediatric tuberculosis.


WHO. Global tuberculosis report, 2019. Available at: Accessed on 02 October 2022.

Anane R. Tuberculosis in African children: epidemiologic, clinical and therapeutic aspects. Med Trop. 2003;63:473‑80.

Ministry of Public Health. Manual of National Tuberculosis Control Program in Madagascar 6th edition. Madagascar: MPH. 2017.

Hesseling AC, Schaaf HS, Gie RP, Starke JR, Beyers N. A critical review of diagnostic approaches used in the diagnosis of childhood tuberculosis. Int J Tuber Lung Dis. 2002;6(12):1038‑45.

Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M et al. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel. J Infect Dis. 2012;205(2):199-208.

Dunn JJ, Starke JR, Revell PA. Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children. J Clin Microbiol. 2016;54(6):1434‑41.

Pearce EC, Woodward JF, Nyandiko WM, Vreeman RC, Ayaya SO. A systematic review of clinical diagnostic systems used in the diagnosis of tuberculosis in children. AIDS Res Treat. 2012;2012:401896.

Sarkar S, Paul DK, Chakrabarti S, Mandal NK, Ghoshal AG. The Keith Edward scoring system: A case control study. Lung India. 2009;26(2):35‑7.

Mbala L, Nsibu N, Mpingiyabo K. Validity of the Keith Edwards scoring system for the diagnosis of childhood pulmonary tuberculosis. Arch Pediatr. 2014;21(1):13‑9.

Edwards DJ, Kitetele F, Van Rie A. Agreement between clinical scoring systems used for the diagnosis of pediatric tuberculosis in the HIV era. Int J Tuberc Lung Dis. 2007;11(3):263‑9.

Brown S, Leavy JE, Jancey J. Implementation of GeneXpert for TB Testing in Low- and Middle-Income Countries: A Systematic Review. Glob Health Sci Pract. 2021;9(3):698‑710.

Narute S, Salgia K, Singhal P, Kalley V. Comparative study of Gene Xpert MTB/RIF, smear microscopy and TB MGIT culture in diagnosis of tuberculosis in India. Eur Respir J. 2015;46(59):PA1533.

Ejeh EF, Undiandeye A, Akinseye VO, Okon KO, Kazeem HM, Kudi CA et al. Diagnostic performance of GeneXpert and Ziehl-Neelson microscopy in the detection of tuberculosis in Benue State, Nigeria. Alexandria J Med. 2018;54(4):529‑33.

WHO. WHO consolidated guidelines on tuberculosis Module 5: Management of tuberculosis in children and adolescents. Switzerland: WHO; 2022.

Ramamonjinirina T, Rakotondravelo S, Rakotojoelimaria E, Rakotoarivelo R. Extra-pulmonary tuberculosis in children hospitalized at Fianarantsoa hospital. Rev Malg Ped. 2019;2(1):110‑8.

Roudies LEH, Matar AE, Jorio M, Tazi AEM. Aspects of infantile tuberculosis. Maroc Med. 2007;29(4):228-35.

Triasih R, Graham SM. Limitations of the Indonesian Pediatric Tuberculosis Scoring System in the context of child contact investigation. Paediatr Indones. 2011;51(6):332‑7.

Randriatsarafara FM, Vololonarivelo BEE, Rabemananjara NNG, Randrianasolo JBO, Rakotomanga J de DM, Randrianarimanana VD. Factors associated with tuberculosis in children at the University Hospital Centre Mother-Child Tsaralalàna, Antananarivo: a case-control study. Pan Afr Med J. 2014;19:224.

Amorissani MF, Gauze JC, Kouamé CK, Dainguy ME, Diomandé D, Houénou Y. Miliary tuberculosis in children. Report of 89 cases in the pediatric department, Abidjan. Mali Med. 2006;21(3):15-8.

Soumana A, Kamaye M, Mamoudou AD, Garba M, Samaila A, Ahidan R et al. Tuberculosis in children: 29 cases in two hospitals of Niamey and at the national tuberculosis center. J Rech Sci Univ Lomé. 2017;19(2):339‑45.

High Council for Public Health (HCSP) working group's, France. Tuberculin intradermal reaction (IDR) or tuberculin test. Med Mal Infect. 2004;34(8):358‑63.

Delacourt C. Specific features of tuberculosis in childhood. Rev Mal Respir. 2011;28(4):529‑41.

Kim WS, Choi JI, Cheon JE, Kim IO, Yeon KM, Lee HJ. Pulmonary Tuberculosis in Infants: Radiographic and CT Findings. Am J Roentgenol. 2006;187(4):1024‑33.

Thumerelle C, Pouessel G, Errera S, Penel-Capelle D, Morillon S, Santos C et al. Radiologic manifestations of pulmonary tuberculosis. Arch Pediatr. 2005;12:S132‑6.

Narayan S, Mahadevan S, Serane VT. Keith Edwards score for diagnosis of tuberculosis. Indian J Pediatr. 2003;70(6):467‑9.

Mutabazi SA, Jumanne S, Mpondo BC, Mnzava DP. Prevalence of culture positive Tuberculosis and utility of a clinical diagnostic tool for the diagnosis of Tuberculosis among HIV Infected Children attending HIV/AIDS Care and Treatment in Dodoma Municipality, Central Tanzania. Int J Infect Dis. 2020;96:593‑9.

Van Rheenen P. The use of the paediatric tuberculosis score chart in an HIV-endemic area. Trop Med Int Health. 2002;7(5):435‑41.

Palmer M, Gunasekera KS, Van der Zalm MM, Morrison J, Simon Schaaf H, Goussard P et al. The Diagnostic Accuracy of Chest Radiographic Features for Pediatric Intrathoracic Tuberculosis. Clin Infect Dis. 2022;ciac011.

Guessous I, Cornuz J, Gaspoz J-M, Paccaud F. Screening: principles and methods. Rev Med Suisse. 2010;6:1390-4.

Ben Hassine D, Chebil D, Melki S, Nouira S, Ben Abdelaziz A, Ben Salem K et al. Evaluation of the performance of a diagnostic test: Reproducibility, Internal validity and External validity. Tunis Med. 2022;100(1):1‑8.




How to Cite

Ali, S. O., Samena, H. S. C., Razafindraibe, K. A., & Robinson, A. L. (2022). Clinico-radiological criteria versus GeneXpert for diagnosis of pediatric tuberculosis. International Journal of Research in Medical Sciences, 10(12), 2744–2749.



Original Research Articles