Hema Aswal, e al. Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis Cases Using Tube culin
Skin Tes . In . J Med. Pha m. Res., 6 (6): 330‐334, 2025
330
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
Resea ch A icle
Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis
Cases Using Tube culin Skin Tes
Hema Aswal1, Ri u Rakholia2, D . Ram Gopal Nau iyal3, D . Bindu Deopa4
1PG 3 Go e nmen medical college Haldwani
2P o esso and Head o Depa men o pedia ics Go e nmen medical college Haldwani
3P o esso and Head o Depa men o Respi a o y Medicine
4Assis an P o esso , Go e nmen medical college Haldwani
A B S T R A C T
Co esponding Au ho :
Hema Aswal
PG 3 Go e nmen medical college
Haldwani
Recei ed: 14-10-2025
Accep ed: 29-10-2025
A ailable online: 12-11-2025
Backg ound: Tube culosis emains a majo cause o mo bidi y in child en,
pa icula ly among household con ac s o pulmona y TB cases. The Tube culin Skin
Tes (TST) is an es ablished, cos -e ec i e ool o sc eening and diagnosing la en
in ec ion in his ulne able g oup.
Objec i es: To es ima e he p e alence o TST posi i i y among pedia ic con ac s
o pulmona y TB pa ien s and o compa e he clinical, socio-demog aphic, and
hema ological p o iles o in ec ed and non-in ec ed child en, iden i ying p edic o s
o la en ube culosis in ec ion.
Me hods: This c oss-sec ional s udy included 384 pedia ic con ac s aged >5 o <15
yea s. A e excluding con i med ac i e TB, 295 child en we e assessed o la en
in ec ion using TST. Clinical his o y, socio-demog aphic ac o s, hema ological and
in lamma o y pa ame e s we e sys ema ically eco ded and s a is ically analyzed.
Resul s: O 295 eligible child en, 174 (58.9%) we e TST posi i e. Posi i i y
inc eased wi h age (p=0.001) bu showed no associa ion wi h sex o socioeconomic
s a us. TST-posi i e child en had signi ican ly lowe hemoglobin, educed TLC,
ele a ed pla ele s, and highe ESR/CRP, e lec ing immune al e a ions linked o
in ec ion.
Conclusion: O e hal o exposed pedia ic con ac s ha bo ed la en TB in ec ion.
TST p o ed eliable in iden i ying in ec ion, wi h highe p e alence in olde
child en and s ong associa ion wi h hema ological and in lamma o y ma ke s,
emphasizing he need o ea ly sc eening and p e en i e s a egies.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Tube culosis, Pedia ic con ac s, Tube culin Skin Tes , La en in ec ion,
Hema ological p o ile, In lamma o y ma ke s.
INTRODUCTION
Tube culosis (TB), caused by Mycobac e ium ube culosis, emains a majo global heal h h ea despi e being
p e en able and cu able [1]. In 2023, an es ima ed 10.8 million new cases and 1.25 million dea hs we e epo ed, placing
TB once again as he leading in ec ious kille [2]. Nea ly one-qua e o he wo ld’s popula ion (~1.7 billion people)
ha bo s la en TB in ec ion (LTBI), o ming a la ge ese oi o u u e disease [3]. Child en a e pa icula ly ulne able,
wi h abou 1.25 million new pedia ic cases and 214,000 dea hs annually, mos occu ing in hose unde i e yea s [4,5].
India con ibu es he highes bu den, accoun ing o 27–28% o global TB cases [3]. The Na ional P e alence Su ey
(2019–2021) es ima ed 312 cases pe 100,000 popula ion, wi h annual incidence exceeding 2.8 million [3]. Pedia ic TB
is unde diagnosed, ye India alone con ibu es nea ly one- hi d o he global childhood bu den [5]. Mul id ug- esis an
TB, o e c owding, and diagnos ic delays u he complica e elimina ion e o s [6].
T ansmission occu s ia inhala ion o d ople nuclei om smea -posi i e pulmona y TB pa ien s, wi h a single un ea ed
case po en ially in ec ing 20–25 con ac s [1]. P ima y TB a ises wi h ini ial in ec ion, while eac i a ion disease de elops
om do man bacilli in immunocomp omised s a es [1]. E ec i e con ol equi es managemen o bo h ac i e disease
and LTBI.
Hema Aswal, e al. Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis Cases Using Tube culin
Skin Tes . In . J Med. Pha m. Res., 6 (6): 330‐334, 2025
331
TB P e en i e T ea men (TPT) is cen al o global elimina ion s a egies. Isoniazid o 6–9 mon hs p e en s up o 90%
o p og ession o ac i e disease, while sho e i ampicin o i apen ine-based egimens show simila e icacy wi h be e
adhe ence [7,8]. In household pedia ic con ac s, TPT educes isk o ac i e TB by nea ly wo- hi ds [8].
MATERIALS AND METHODS
This was a c oss-sec ional obse a ional s udy conduc ed a he Depa men o Pedia ics and he Tube culosis Uni ,
Go e nmen Medical College, Haldwani, om Decembe 2023 o June 2025.
S udy Popula ion:
All child en aged >5 yea s o <15 yea s who we e household con ac s o con i med ube culosis (TB) cases we e
conside ed o inclusion.
Inclusion C i e ia:
1. Pedia ic con ac s o an index TB pa ien .
2. Child en aged >5 and <15 yea s.
Exclusion C i e ia:
1. Child en <5 o >15 yea s.
2. Those al eady diagnosed wi h ac i e TB and ecei ing an i- ube cula he apy (ATT).
3. Child en on TB p e en i e he apy o diagnosed la en ube culosis in ec ion.
Sample Size Calcula ion:
Using he o mula N = z²pq/d², wi h z = 1.96 (95% con idence le el), p = 50%, q = 50%, and d = 5%, he calcula ed
sample size was 384.
Me hodology:
Child en mee ing he inclusion c i e ia we e en olled consecu i ely. A e ob aining ele an his o y and clinical
e alua ion, a ube culin skin es (TST) was pe o med. The p ocedu e in ol ed in ade mal injec ion o 0.1 ml o 2 TU
o 5 TU PPD (depending on a ailabili y) in o he ola aspec o he o ea m using a ube culin sy inge wi h he be el
acing upwa d. A 6–10 mm wheel con i med co ec placemen .
TST eadings we e done a 48–72 hou s by ained heal h pe sonnel. The diame e o indu a ion (no e y hema) was
measu ed pe pendicula o he o ea m. In e p e a ion was based on s anda d cu -o s:
• ≥15 mm: Con i med TB in ec ion ega dless o BCG s a us.
• 10–14 mm: Possible TB in ec ion o BCG/en i onmen al mycobac e ia-induced sensi i i y.
• 5–9 mm: Likely BCG c oss- eac i i y unless immunosupp ession is p esen .
• <5 mm: Conside ed nega i e unless se e ely immunocomp omised.
Pos -TST Ca ego iza ion:
Child en wi h a posi i e TST unde wen clinical and adiological sc eening o ule ou ac i e TB. I no e idence o
disease was ound, hey we e classi ied as ha ing la en TB in ec ion (LTBI).
This s uc u ed, algo i hm-based app oach enabled a ge ed e alua ion and app op ia e ca ego iza ion o TB exposu e
ou comes in pedia ic con ac s.
Figu e 1: Algo i hm o Ta ge ed Diagnosis and T ea men o La en Tube culosis In ec ion (LTBI) and
Tube culosis (TB)
Hema Aswal, e al. Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis Cases Using Tube culin
Skin Tes . In . J Med. Pha m. Res., 6 (6): 330‐334, 2025
332
RESULTS
In his s udy o 295 pedia ic con ac s o TB cases, TST posi i i y signi ican ly inc eased wi h age (χ²=13.3, d =2,
p=0.001). Among 5–8 yea s (n=108), 49 (45.4%) we e posi i e; in 9–12 yea s (n=105), 72 (68.6%) we e posi i e; and in
13–15 yea s (n=82), 53 (64.6%) we e posi i e. Compa ed wi h 5–8 yea s, posi i i y inc eased by +23.2% and +19.2% in
olde g oups. By sex, 87/157 emales (55.4%) and 87/138 males (63.0%) we e posi i e, wi h no signi ican di e ence
(χ²=1.77, p=0.184). Socioeconomic s a us showed no associa ion (χ²=1.45, p=0.486), wi h posi i i y ~59% in bo h lowe
middle and middle class.
Table 1. ASSOCIATION OF T ea men Ou come WITH TST
Ou come
TST (N)
TST (P)
To al
An i-TB he apy (ATT)--ACTIVE TB
35
54
89
P e en i e he apy (TPT)--LATENT TB
0
174
174
No he apy needed–NO TB
121
0
121
To al
156
228
384
In able 1 384 pedia ic con ac s o pulmona y TB cases we e sc eened wi h TST, o which 228 (59.4%) we e posi i e.
Eigh y-nine (23.2%) had ac i e TB and ecei ed ATT, lea ing 295 child en o LTBI assessmen . Among hem, 174
(58.9%) we e TST posi i e, con i ming LTBI, while 121 (41.0%) we e nega i e. All LTBI cases we e TST posi i e and
all unin ec ed child en nega i e, alida ing TST as a eliable disc imina o o la en in ec ion.
Table 2. Compa ison o Hema ological Pa ame e s Be ween TST Nega i e and TST Posi i e G oups
Pa ame e
TST (N) (Mean ± SD)
TST (P) (Mean ± SD)
p- alue
Hemoglobin (g/dL)
11.4 ± 2.04
10.70 ± 2.29
0.001
TLC (cells/mm³)
12 214 ± 1 318
8 110 ± 744
0.001
Pla ele s (×10⁵/mm³)
2.62 ± 1.21
3.10 ± 1.77
0.001
Table 2 shows Among 295 pedia ic con ac s, TST-posi i e child en showed lowe mean hemoglobin (10.7 ± 2.29 g/dL
s. 11.4 ± 2.04 g/dL) and educed TLC (8,110 ± 744 s. 12,214 ± 1,318 cells/mm³), along wi h highe pla ele coun s
(3.10 ± 1.77 s. 2.62 ± 1.21 ×10⁵/mm³) compa ed o TST-nega i e con ac s. All di e ences we e s a is ically signi ican
(p = 0.001), indica ing ha TST posi i i y was associa ed wi h mild anemia, leukopenia, and eac i e h ombocy osis,
consis en wi h immune al e a ions seen in TB in ec ion.
Figu e 2: Associa ion O In lamma o y Ma ke Wi h Ts
In Figu e 2 among pedia ic con ac s, in lamma o y ma ke s showed signi ican associa ion wi h TST s a us. Child en
wi h ele a ed ESR (>20 mm/h ) we e mo e o en TST posi i e (9/18; 50.0%) compa ed o hose wi h no mal ESR (1/13;
7.7%). This associa ion was s a is ically signi ican (p = 0.021). Simila ly, CRP posi i i y co ela ed wi h highe TST
posi i i y (8/21; 38.1%) compa ed o CRP-nega i e child en (7/21; 33.3%), wi h s a is ical signi icance (p = 0.017).
Hema Aswal, e al. Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis Cases Using Tube culin
Skin Tes . In . J Med. Pha m. Res., 6 (6): 330‐334, 2025
333
Figu e 3: P e alence o TB In ec ion among Pedia ic Con ac s
Figu e 3 p esen c oss-sec ional s udy, 295 pedia ic household/close con ac s o bac e iologically con i med pulmona y
ube culosis cases we e e alua ed using he Tube culin Skin Tes (TST). Ou o hese, 174 child en (58.98%) we e TST
posi i e, while 121 (41.02%) we e TST nega i e.This inding indica es ha nea ly six ou o e e y en exposed child en
ha bo ed ube culosis in ec ion, e lec ing ei he la en TB in ec ion o ea ly ac i e in ec ion. The high p e alence
emphasizes he subs an ial hidden ese oi o in ec ion in pedia ic con ac s, who a e a isk o p og ession o ac i e
disease i le un ea ed.
DISCUSSION
In he p esen s udy, TST posi i i y was 59.4% among 384 pedia ic con ac s, and a e excluding ac i e TB cases, 58.9%
we e classi ied as LTBI, closely aligning wi h he global LTBI bu den o 23% es ima ed by Houben and Dodd (2016)⁶,
hough he p e alence in ou coho was subs an ially highe , e lec ing endemic ansmission. Age-wise, posi i i y ose
om 45.4% in 5–8 yea s o 68.6% in 9–12 yea s and 64.6% in 13–15 yea s (χ²=13.3, p=0.001), which pa allels he ise in
incidence du ing adolescence desc ibed by Snow e al. (2020)⁵, highligh ing he inc easing ulne abili y in olde child en.
The lack o sex o socioeconomic associa ion in ou s udy con as s wi h Dodd e al. (2017)⁷, who no ed dispa i ies
in luenced by HIV and ea men gaps, hough hese we e mo e p ominen in global mo ali y han in ec ion p e alence.
Bonne e al. (2023)⁹ simila ly unde sco ed high ulne abili y in malnou ished and HIV-posi i e child en, which
con ex ualizes he hema ological indings in ou coho , whe e TST-posi i e con ac s demons a ed lowe hemoglobin
(10.7 ± 2.29 g/dL), educed TLC (8,110 ± 744/mm³), and highe pla ele coun s (3.10 ± 1.77 ×10⁵/mm³) compa ed o
nega i es, all signi ican a p=0.001. These immune and hema ological al e a ions a e consis en wi h in ec ion- ela ed
in lamma o y esponses. Unique o ou indings is he clea demons a ion ha all LTBI cases we e TST posi i e,
ein o cing i s eliabili y in iden i ying la en in ec ion among exposed child en.In his s udy, 58.9% o pedia ic con ac s
we e TST posi i e, e lec ing a conside able bu den o la en in ec ion, consis en wi h he high global LTBI es ima es by
Houben and Dodd (2016)⁶ and he ulne abili y o child en highligh ed by Dodd e al. (2017)⁷. Ele a ed ESR (>20
mm/h ) and CRP posi i i y we e signi ican ly associa ed wi h TST posi i i y (p=0.021 and p=0.017), indica ing an ac i e
in lamma o y esponse, in line wi h Bonne e al. (2023)⁹, who no ed sys emic ma ke s p edic ing se e e ou comes.
Clinically, pulmona y TB cases showed s onge TST posi i i y, whe eas CNS TBM was mos ly TST nega i e, e lec ing
he a iabili y in immune esponse desc ibed by Ma ais e al. (2004)⁸. Unique o his s udy is he de ailed co ela ion
be ween TST eac i i y and o gan-speci ic disease pa e ns, wi h signi ican associa ion (χ²=23.01, p=0.00076).
CONCLUSION
This s udy demons a ed ha ube culosis in ec ion is highly p e alen among pedia ic household con ac s, wi h 58.9%
showing TST posi i i y a e excluding ac i e TB, unde sco ing a subs an ial hidden ese oi o in ec ion. Posi i i y
signi ican ly inc eased wi h age, con i ming g ea e ulne abili y in olde child en, while sex and socioeconomic s a us
showed no in luence. Hema ological al e a ions, including lowe hemoglobin, leukopenia, and h ombocy osis, along
wi h ele a ed ESR and CRP, we e s ongly associa ed wi h TST posi i i y, e lec ing immune ac i a ion in in ec ed
child en. Clinically, pulmona y TB showed s ong co ela ion wi h TST eac i i y, whe eas CNS ube culosis displayed
poo sensi i i y, highligh ing a iabili y in immune esponses ac oss disease si es. Collec i ely, hese indings es ablish
TST as a eliable, cos -e ec i e ool o de ec ing la en in ec ion in pedia ic con ac s, emphasize he impo ance o ea ly
sc eening and p e en i e he apy, and ein o ce he need o a ge ed s a egies o educe p og ession om la en o
ac i e TB in his ulne able popula ion
Hema Aswal, e al. Diagnosis O Tube culosis In ec ion In Pedia ic Con ac s O Tube culosis Cases Using Tube culin
Skin Tes . In . J Med. Pha m. Res., 6 (6): 330‐334, 2025
334
Con lic o In e es : None.
Funding: None.
E hical App o al: Ob ained.
Consen : W i en consen secu ed.
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