PEDIATRIC TUBERCULOSIS: DIAGNOSTIC CHALLENGES AND FUTURE STRATEGIES

Abstract

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.