A tuberculose na infância e na adolescência é difícil de diagnosticar?

Abstract

Objective: To determine the sensitivity of the scoring system proposed by the Brazilian National Ministry of Health in 2002 for the diagnosis of tuberculosis in children and adolescents suspected of having the disease. Methods: This was a retrospective study of 316 children and adolescents (0-14 years of age) diagnosed with pulmonary tuberculosis between 1997 and 2007 at the Brazilian Institute for Tuberculosis Research, located in the city of Salvador, Brazil. After reviewing the medical charts and chest X-rays of the patients, we calculated the tuberculosis scores. Results: The majority of the subjects (80.4%) had a history of close household contact with an AFB-positive adult within the last two years. The tuberculin test was negative in 11 subjects (3.5%). According to the scoring system, 251 (79.4%) were very likely to have tuberculosis (score, ≥ 40), 63 (19.9%) were moderately likely to have tuberculosis (score, 30-35), and 2 (0.7%) were unlikely to have tuberculosis (score, ≤ 25). When a cut-off score of 30 was used, the sensitivity of this scoring system was 99.3%. Conclusions: In our sample, the sensitivity of this scoring system was high when the selected cut-off score was employed. If a cut-off score of 40 had been used, 20% of the subjects would not have been treated. Therefore, scores between 30 and 35 are critical for diagnostic confirmation. Judicious clinical evaluation should prevail in the decision of treating these patients. When the cut-off score of 30 is used, 30% of individuals with other pathologies will be treated for tuberculosis. This highlights the need for improved diagnostic methods for tuberculosis.

Tuberculose Em Pacientes Pediátricos: Como Tem Sido Feito O Diagnóstico?

“…15 Consequently, an increase in false positives may occur, which means that approximately 30% of patients starting treatment for TB might be carriers of other diseases. 18 The analysis of the use of the point system was not possible in this study due to the long time span considered (1999-2014), as it includes periods prior to the implementation of the system by the Ministry of Health.…”

Tuberculose em crianças: desafios no diagnóstico

“…A importância da avaliação dos contatos, é uma ação de controle e enfrentamento da TB essencial, considerando a elevada contagiosidade que um adulto bacilífero com TB pulmonar apresenta, o que faz dele um disseminador dessa patologia. Contudo, a identificação desses contatos precisa melhorar, uma vez que a investigação muitas vezes não acontece nem em um quarto dos casos (Coelho Filho et al, 2011;Cruz & Velásquez, 2012;Sant'Anna, 2012).…”

“…A radiografia se caracteriza como suporte na avaliação da TB pulmonar na população de modo geral e contribui com os sistemas de escores supracitados (Cano et al, 2017;Chen et al, 2013;Chiappini et al, 2016;Coelho Filho et al, 2011;Cruz & Velásquez, 2012;Graham, 2011;Perez-Porcuna et al, 2012;Rahman et al, 2012;Roya-Pabon & Marais, 2017;Sant'Anna, 2012;Shingadia, 2012).…”

Latent tuberculosis infection and tuberculosis in children and adolescents

“…When we compared our results to those of a study conducted in Salvador, in the State of Bahia, between 1997 and 2007, with TB patients <14 years old, we found a similar proportion of identified household contact (77.8% versus 80.4%), a higher proportion of normal chest X-rays (29.6% versus 0.3%), and a lower proportion of nutritional status adequacy (74.1% versus 82.2%). ( 11 ) Regarding this last aspect, there is evidence that malnutrition is a risk factor for TB, ( 12 ) and it is a score criterion for its diagnosis. ( 5 ) However, in our sample, approximately 96% of patients diagnosed with TB were eutrophic or weight excess.…”