A Refined Symptom-Based Approach to Diagnose Pulmonary Tuberculosis in Children

Marais, Ben J.; Gie, Robert P.; Hesseling, Anneke C.; Schaaf, H. Simon; Lombard, Carl; Enarson, Donald A.; Beyers, Nulda

doi:10.1542/peds.2006-0519

Cited by 252 publications

(215 citation statements)

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“…(12) Although over 50% of the cases of pulmonary TB in children might be asymptomatic, the literature shows that the combination of persistent cough for at least two weeks and asthenia, adynamia and weight loss has diagnostic value for the disease. (13)(14)(15) In the present study, fever, cough, asthenia and weight loss had the greatest statistical relevance for the diagnosis of TB. Although the LTB group, by definition, was the group in which the patients presented with fewer symptoms, cough for less than two weeks was observed in 29.6% of the cases, probably due to acute infections of the upper airways.…”

Section: Discussionmentioning

confidence: 54%

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Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV

et al. 2010

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Objective: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. Methods: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. Results: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0% and 86.1% in the TB group, versus 75.0% and 58.3% in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0% and 53.9%, revealing combined parenchymal/ lymph node alterations in 18.2% and 30.8%. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3% of the patients were malnourished (p < 0.005 vs. the LTB group).The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. Conclusions: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.Keywords: Tuberculosis/diagnosis; HIV seropositivity; Diagnostic techniques and procedures. ResumoObjetivo: Verificar a eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde (MS), para o diagnóstico de TB pulmonar em crianças e adolescentes, infectadas ou não pelo HIV. Métodos: Estudo analítico transversal realizado entre janeiro de 2002 e dezembro de 2006, no qual foram incluídos 239 indivíduos menores de 15 anos. Os pacientes foram divididos em quatro grupos: grupo TB latente (TBL; n = 81); grupo não TB (NTB; n = 41); grupo TB (n = 104); e grupo TB/HIV (n = 13). Foram estudadas as características clínicas, radiológicas e laboratoriais segundo o sistema de pontuação. Resultados: Os relatos de febre, tosse, astenia e emagrecimento há mais de duas semanas foram significativamente maiores no grupo TB (p < 0,0001 Considering the clinical findings, the complementary test results and the evolution of each case after a 30-day observation period, the following groups were formed:• Latent TB (LTB) group: asymptomatic patients with a history of contact with an adult TB patient, normal chest X-ray and positive TST result (induration greater than 10 mm in size).• No-TB (NTB) group: patients with other pulmonary diseases (diagnosed based on clinical and radiological findings) in whom the disease evolved satisfactorily without the use of ant...

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Section: Discussionmentioning

confidence: 54%

“…(14,15) Asthenia and weight loss were more frequently reported in TB patients (regardless of HIV status). Weight loss for longer than two weeks was observed in 39.6% of the children in the TB group and in 69.2% of the children in the TB/HIV group, which suggests that general health in these groups of patients was more significantly affected.…”

Section: Discussionmentioning

confidence: 99%

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV

et al. 2010

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“…The sputum smears are positive in only 10%-15% and culture positivity is detected in only 30%-40% of the children (7,(10)(11)(12). Gastric aspirate culture yielded M. tuberculosis from one of our five patients who could be tested.…”

Section: Discussionmentioning

confidence: 82%

“…After primary M. tuberculosis infection disease progression is rare in these children and is associated with the presence of persistent nonremitting symptoms. However the children who are 3 years of age and/or immune compromised progression of infection to disease and disease progression is more frequent and may disseminate more rapidly (11).…”

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confidence: 99%

Pulmonary tuberculosis in infants less than one year old: implications for early diagnosis

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et al. 2011

Tuberk Toraks

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“…For these reasons, microbiological confirmation of childhood tuberculosis is rare and clinical diagnosis relies on a combination of signs, symptoms, radiological findings, and identification of a tuberculosis contact. 4 The ongoing rollout of Xpert MTB/RIF (Xpert; Cepheid, Sunnyvale CA, USA) in lowincome and middle-income countries offers an opportunity for investigators to provide access to diagnosis for children beyond smear microscopy. We did a systematic review and meta-analysis on the use of Xpert in children, which informed the recent WHO update of guidelines on the use of Xpert in adults and children.…”

Section: Introductionmentioning

confidence: 99%

Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and meta-analysis

2015

Indian Journal of Tuberculosis

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A Refined Symptom-Based Approach to Diagnose Pulmonary Tuberculosis in Children

Cited by 252 publications

References 18 publications

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV

Pulmonary tuberculosis in infants less than one year old: implications for early diagnosis

Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: A systematic review and meta-analysis

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