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

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dc.contributor.authorMarais B.J.
dc.contributor.authorGie R.P.
dc.contributor.authorHesseling A.C.
dc.contributor.authorSchaaf H.S.
dc.contributor.authorEnarson D.A.
dc.contributor.authorBeyers N.
dc.date.accessioned2011-05-15T16:00:07Z
dc.date.available2011-05-15T16:00:07Z
dc.date.issued2006
dc.description.abstractBackground: 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.
dc.description.versionArticle
dc.identifier.citationPediatric Infectious Disease Journal
dc.identifier.citation25
dc.identifier.citation3
dc.identifier.issn8913668
dc.identifier.other10.1097/01.inf.0000202140.76368.74
dc.identifier.urihttp://hdl.handle.net/10019.1/11534
dc.subjectisoniazid
dc.subjecttuberculostatic agent
dc.subjectarticle
dc.subjectdisease classification
dc.subjectendemic disease
dc.subjectextrathoracic tuberculosis
dc.subjectfemale
dc.subjecthealth care access
dc.subjecthousehold
dc.subjecthuman
dc.subjectintrathoracic tuberculosis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectnonhuman
dc.subjectpreschool child
dc.subjectprimary health care
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectscreening test
dc.subjectSouth Africa
dc.subjectsputum smear
dc.subjectsymptomatology
dc.subjectthorax radiography
dc.subjecttuberculosis
dc.subjectworld health organization
dc.subjectAntitubercular Agents
dc.subjectChild, Preschool
dc.subjectContact Tracing
dc.subjectFemale
dc.subjectHealth Resources
dc.subjectHumans
dc.subjectMale
dc.subjectMass Screening
dc.subjectSouth Africa
dc.subjectTuberculin Test
dc.subjectTuberculosis
dc.subjectTuberculosis, Pulmonary
dc.titleRadiographic signs and symptoms in children treated for tuberculosis: Possible implications for symptom-based screening in resource-limited settings
dc.typeArticle
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