Smear and Xpert MTB/RIF Negative Tuberculosis: A Lingering Dilemma in Children and the HIV Infected – Two Case Reports

Abstract

Confirmatory diagnosis of tuberculosis(TB) in children and human immunodeficiency virus‑infected individuals continues to pose a challenge in resource-limited settings. Although the Xpert MTB/RIF assay is sensitive and rapid, its ability to detect Mycobacterium tuberculosis is low in smear-negative TB, a compelling situation to resort to empirical therapy based on high index of suspicion. We report two cases clinically suspected to be TB in whom repeated sputum smear microscopy and Xpert MTB/RIF tests were negative, but based on high index of suspicion and the World Health Organization recommended clinical criteria, both were commenced on anti-TB therapy and made remarkable recovery at treatment completion.