Proposal of an improved score method for the diagnosis of pulmonary tuberculosis in childhood in developing countries

Study of the antibody response against Mycobacterium tuberculosis antigens in Warao Amerindian children in Venezuela

“…A single serum sample and saliva sample were collected from all children studied (of either sex and with average age of 8.24 ± 4.84 years old). Bearing in mind that the WHO uses the criteria of presence of weight loss or inadequate weight gain, coughing or wheezing and a history of household contact with an adult case of lung TB, and that these criteria have had a positive predictable value between 63% and 70% (Migliori et al 1992, Houwert et al 1998, we adopted a previously-reported scheme (Fernández de Larrea et al 2002), which takes into account the clinical, nutritional, and epidemiological factors in the children, specifically (1) clinical and nutritional criteria and positive reactivity to tuberculin, and (2) clinical and nutritional criteria, with negative tuberculin and positive household contact. During our study specific attention was given to Warao children with respiratory symptoms which suggested TB and were therefore further evaluated with a chest X-ray.…”

Avaliação do sistema de pontuação para o diagnóstico da tuberculose na infância preconizado pelo Ministério da Saúde, Brasil

“…Nas crianças, os índices baixos de positividade da cultura do escarro ou do lavado gástrico (30% a 40%) estão pautados, além de problemas técnicos, na própria patogênese da doença nesta faixa etária, que é paucibacilar, o que dificulta ainda mais a confirmação bacteriológica 12,13,14,15,16 .…”

“…Existem atualmente seis sistemas de pontuação para o diagnóstico da tuberculose infantil propostos nos últimos anos por pesquisadores ou órgãos ligados à área da saúde de diversos países 17,18,19,20,21,22 . Alguns desses sistemas não são aplicáveis a países como o Brasil, onde a doença é considerada de alta endemicidade e a vacinação com BCG intradérmico faz parte do calendário oficial de vacinação 23 .…”

Structured approaches for the screening and diagnosis of childhood tuberculosis in a high prevalence region of South Africa

“…Structured diagnostic approaches were categorized as follows: i) binary, with the diagnosis being simply positive or negative (yes = tuberculosis; no = not tuberculosis); 12,15 ii) hierarchical, with stratification into categories of diagnostic certainty, such as "definite", "probable", "possible", "unlikely" or "not tuberculosis"; 8,14,16 or iii) numerical, with a score obtained by adding the weighted values assigned to each variable (score ≥ x = tuberculosis). [9][10][11]13 Data for the variables used in these diagnostic approaches were collected prospectively during the trial.…”

“…5,[8][9][10][11][12][13][14][15][16][17] Hesseling et al reviewed 16 such approaches and noted that few of the scoring systems, algorithms and classifications for the screening and diagnosis of childhood tuberculosis have been validated against a gold standard. Most have been developed for hospital-based studies and their usefulness in community settings is relatively unknown.…”