Multiplex PCR in pediatric LRTIs: challenges and opportunities in LMICs

Jelitha Ramachanderam; Khuen F Ng; Chuin-Hen Liew; Kah K Tan

doi:10.3855/jidc.22952

Authors

Jelitha Ramachanderam UCSI Medical School, Faculty of Medicine and Health Sciences, UCSI University , 71010 Port Dickson, Negeri Sembilan, Malaysia https://orcid.org/0009-0004-1317-594X
Khuen F Ng Pediatric Immunology and Infectious Diseases Department, Great North Children’s Hospital, NE1 4LP, Newcastle upon Tyne, Tyne and Wear, England https://orcid.org/0000-0002-8767-3974
Chuin-Hen Liew Department of Pediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia https://orcid.org/0000-0001-8775-0303
Kah K Tan UCSI Medical School, Faculty of Medicine and Health Sciences, UCSI University , 71010 Port Dickson, Negeri Sembilan, Malaysia https://orcid.org/0000-0002-8445-5816

DOI:

https://doi.org/10.3855/jidc.22952

Keywords:

healthcare, pneumonia, mortality, infectious diseases, antibiotics, childhood

Abstract

Introduction: Lower respiratory tract infections (LRTIs) remain a leading cause of morbidity and mortality among children under five years of age, particularly in low- and middle- income countries (LMICs), where limitations in diagnostic capacity contribute to delayed and suboptimal clinical management. Conventional diagnostic methods are limited by slow turnaround time and reduced sensitivity, especially in mixed infections. This review synthesizes current evidence on the role of multiplex polymerase chain reaction (MxPCR) in the diagnosis and management of pediatric LRTIs, with emphasis on diagnostic accuracy, clinical impact, and implementation considerations in LMIC settings.

Methodology: A narrative review of published literature was undertaken, focusing on studies evaluating MxPCR diagnostic performance, clinical outcomes, epidemiological insights, and cost-effectiveness in pediatric respiratory infections, with cross-reference to LMIC specific health system constraints.

Observations: MxPCR consistently demonstrates high sensitivity and specificity for the detection of viral, bacterial, and mixed respiratory pathogens, enabling rapid and comprehensive pathogen identification. Evidence indicates improved antibiotic stewardship, reduced unnecessary investigations, and strengthened epidemiological surveillance. However, widespread adoption in LMICs remains limited by high per-test costs, infrastructure requirements, supply chain challenges, and limited local economic evaluation.

Conclusions: MxPCR represents a valuable diagnostic advancement for pediatric LRTIs. Sustainable integration in LMICs will require context-specific cost-effectiveness studies, appropriate panel selection based on local epidemiology, and feasible funding. Until these conditions are met, selective use in tertiary or high-dependency pediatric settings, or case-by-case application based on severity, remains the most practical approach.

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Author Biographies

Khuen F Ng, Pediatric Immunology and Infectious Diseases Department, Great North Children’s Hospital, NE1 4LP, Newcastle upon Tyne, Tyne and Wear, England

Dr Khuen Foong Ng is a consultant in paediatric immunology and infectious diseases at the Great North Children's Hospital. Dr Khuen Foong Ng has been practicing in clinical paediatrics since 2006. He went into Paediatric Infectious Diseases training in Malaysia in 2013 before going on to do a 2-year fellowship in Paediatric Immunology, Infectious Diseases, Allergy and haematopoietic stem cell transplantation (HSCT) in Newcastle.

In the UK, Dr Ng completed 3 years of Paediatric Immunology and Infectious Diseases (PIID) subspecialty training in Bristol before securing locum consultant post in this field in Bristol and Cardiff.

Dr Ng is now a consultant in PIID and HSCT at Newcastle since March 2024. Besides his clinical commitment in PIID and HSCT (e.g. clinics, ward rounds, on call rota etc), Dr Ng is also the Quality in Primary Immunodeficiency Services (QPIDS) lead.

Chuin-Hen Liew, Department of Pediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

Dr Liew Chuin Hen is a paediatrician at Hospital Tuanku Ampuan Najihah, and Deputy Head at the hospital’s Clinical Research Centre. He received his MD from Universiti Sains Malaysia (2012), a Master of Paediatrics from the University of Malaya (2021), and a Master of Health Informatics and Analytics from IMU University (2024). His research spans general paediatrics, respiratory viral infectious diseases, neonatology, and digital health. His work has appeared in Scientific Reports, BMC Infectious Diseases, Pediatrics International, The Clinical Respiratory Journal, and other journals. Besides, he is now appointed as a seasonal Peer Reviewer at BMJ Digital Health & AI. He also serves as an invited peer reviewer for journals including PLOS Digital Health, Scientific Reports, and BMJ Case Reports.

Dr Liew has led and managed multiple research projects and has provided statistical and methodological consultation for more than 50 clinical studies, including systematic reviews and validation studies. He is a part-time undergraduate medical lecturer at UCSI University and a supervisor for paediatric specialist training, and he delivers teaching on biostatistics, evidence-based medicine, and research methodology.

Kah K Tan, UCSI Medical School, Faculty of Medicine and Health Sciences, UCSI University , 71010 Port Dickson, Negeri Sembilan, Malaysia

Prof. Kah Kee Tan is Professor of Pediatrics at the Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia. He undertook subspecialty training in pediatric infectious diseases at Alberta Children’s Hospital, Canada, completing his fellowship in 1995. Subsequently, he served as a Pediatric Infectious Disease Consultant with the Ministry of Health Malaysia and contributed as a training supervisor in the national subspecialty fellowship program in pediatric infectious diseases. His research interests encompass the epidemiology of infectious diseases, vaccination strategies, respiratory infections, and COVID-19.