Radiographic signs and symptoms in children treated for tuberculosis: Possible implications for symptom-based screening in resource-limited settings

Date
2006
Authors
Marais B.J.
Gie R.P.
Hesseling A.C.
Schaaf H.S.
Enarson D.A.
Beyers N.
Journal Title
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Volume Title
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Abstract
Background: The World Health Organization advises active tracing of children younger than 5 years old in household contact with a sputum smear-positive tuberculosis index case. This study compared radiographic disease manifestations in 2 groups of children treated for tuberculosis in an endemic setting: those who presented with suspicious symptoms; and those actively traced as household contacts of an adult index case. Methods: We conducted a prospective descriptive study from February 2003 through October 2004 at 5 primary health care clinics in Cape Town South Africa, including all children (younger than 5 years old) treated for tuberculosis (TB). Results: A total of 326 children (younger than 5 years old) received antituberculosis treatment; 190 (58.3%) presented with suspicious symptoms, and 136 (41.7%) were actively traced contacts. Children were categorized as; "not TB" 71 (22%), intrathoracic tuberculosis 230 (70%) and extrathoracic tuberculosis 25 (8%). Significantly more actively traced contacts were categorized as "not TB" (odds ratio, 7.4; 95% confidence interval, 3.8-14.3), or demonstrated elements of the primary complex only on the chest radiograph (odds ratio, 26.2; 95% confidence interval, 8.6-89.2), compared with children who presented with suspicious symptoms. Of all children diagnosed with intrathoracic tuberculosis, 20 of 230 (9%) reported no symptoms, all of whom demonstrated elements of the primary complex only. Conclusions: The majority of actively traced contacts had minimal disease. Symptom-based screening would have identified all but 9% of children diagnosed with intrathoracic tuberculosis, all of whom demonstrated elements of the primary complex only. Further investigation is required to establish whether symptom-based screening can be justified to improve access to preventive chemotherapy in resource-limited endemic settings. Copyright © 2006 by Lippincott Williams & Wilkins.
Description
Keywords
isoniazid, tuberculostatic agent, article, disease classification, endemic disease, extrathoracic tuberculosis, female, health care access, household, human, intrathoracic tuberculosis, major clinical study, male, nonhuman, preschool child, primary health care, priority journal, prospective study, screening test, South Africa, sputum smear, symptomatology, thorax radiography, tuberculosis, world health organization, Antitubercular Agents, Child, Preschool, Contact Tracing, Female, Health Resources, Humans, Male, Mass Screening, South Africa, Tuberculin Test, Tuberculosis, Tuberculosis, Pulmonary
Citation
Pediatric Infectious Disease Journal
25
3