1. There is a substantial change in the new case definition of presumptive pediatric TB; it refers to children with persistent fever and/or cough for more than two weeks with loss of weight / no weight gain and/ or history of contact with infectious TB cases. In this article [1], cough was given more importance; however, fever is a more significant symptom of pediatric TB. Furthermore, authors did not mention about history of contact with infectious TB cases, which is an important supportive feature in the diagnosis of pediatric TB [3].

2. In newly updated guidelines, chest X-ray and tuberculin skin test are advised to be performed upfront in cases of presumptive pediatric TB, which is considered as a significant change from the earlier guidelines. If X-ray is highly suggestive of TB (miliary, hilar or mediastinal lymphadenopathy, fibro-cavitory lesion) or shows persistent non-specific shadow even after a course of antibiotics, only microbiological sample is recommended [2,3]. However, this review article suggests that both smear examination and chest X-ray should be done upfront.

3. In previous guidelines and as per this review [1], Cartridge based nucleic acid assay (CBNAAT) is to be performed on the second sample if the first smear is negative, while as per the newly updated guidelines, CBNAAT is considered as the investigation of choice, and it should be ordered upfront in the first sample. Furthermore, in new guidelines, the preferred term is WHO-approved Rapid Diagnostic Test (WRDT), which also include Line probe assay (LPA) and Loop-mediated isothermal amplification (LAMP) apart from CBNAAT [2,3].

4. Category II anti-tubercular therapy (ATT) which was used to treat previously treated cases of TB has been withdrawn from newly updated guideline as it may lead to increased incidence of drug-resistant TB (DRTB) at the cost of low success rate [2]. In such cases, both WHO and RNTCP guideline now recommend that treatment should be guided by drug susceptibility test.