Background: To create a rapid, simple and relatively inexpensive screening strategy for childhood tuberculosis (TB) that includes antibody detection assays to improve the accuracy of microscopic examination of sputum for acid-fast bacilli (AFB smear) in Warao indigenous childhood TB given that TB is difficult to diagnose, and invasive procedures cannot be used to select samples in these communities. Methods: TB diagnosis was established by Mycobacterium tuberculosis culture, clinical diagnosis, thorax radiography and smears stained with Ziehl-Neelsen. HIV status was determined by commercial serologic test. Efficacy and diagnostic potential of different secretory antigens of Mycobacterium tuberculosis (rESAT-6, (17) Ag85A and (5) ESAT-6 synthetic peptides) in the detection of specific IgG antibody profiles of childhood TB cases were evaluated using ELISA technique and sensitivity was compared with the gold standards (smear and culture). A total population of 117 children under the age of 15 years old residing in the visited indigenous communities was examined. Secretions of the pharynx and attempts to obtain samples of sputum by expectoration in children older than 10 years old was carried out in all highly suspected pulmonary TB cases. Serum samples were obtained from 39 untreated children patients, and 78 healthy children. ROC curve analysis was used to calculate the sensitivity and specificity of each antigen for antibody detection. Results: The results revealed no case of HIV-positive TB among Warao children. Bacteriological confirmation had 8.8% sensitivity, Ag85A peptides showed better sensitivity and specificity than ESAT-6 peptides; anti-29880 peptide test was found to be showing highest sensitivity of 100.0% (Negative Predictive Value, NPV = 100) but a low specificity of 20.8%. Two tests were highly specifics, anti-11003 had 97.4% specificity (Positive predictive Value, PPV = 85.7) and 32.4% sensitivity and anti-10999 had 96.2% specificity (PPV = 86.4) and 48.7% sensitivity. Compared to bacteriological tests, sensitivity of a combination that included a two-antigen ELISA (29880 and 11003 synthetic peptides) was significantly higher, p < 0.0001. Conclusion: Our results demonstrate that the potential of combinatorial use of antibodies directed at different epitopes of Ag85A protein could provide a screening strategy for developing a multi-antigen ELISA, which allows an increase in the diagnostic accuracy of pulmonary TB in Warao childhood population. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive