A critical look at the diagnostic value of culture-confirmation in childhood tuberculosis
Date
2006
Authors
Engelbrecht A.L.
Marais B.J.
Donald P.R.
Schaaf H.S.
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Journal ISSN
Volume Title
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Abstract
Objectives: To describe the clinical presentation, delay in diagnosis and treatment initiation, and outcome of culture-confirmed childhood tuberculosis. Methods: Retrospective study of children < 13 years of age at Tygerberg Children's Hospital, Cape Town, South Africa with culture-confirmed tuberculosis seen January 2002-June 2003. Data were collected by review of hospital and clinic records. Results: Culture-confirmed tuberculosis was diagnosed in 184 children, median age 36 months; 26 (14.1%) were diagnosed clinically and treatment was started before admission. Tuberculosis was newly diagnosed in 158 children; 127 (80.4%) were clinically diagnosed and 31 (19.6%) were diagnosed only after culture result was known (culture-diagnosed). The median time from admission to diagnosis was 1 day (1-21 days) for clinically diagnosed, and 73 (34-178 days) for culture-diagnosed children. Treatment was initiated by hospital physicians in all 127 clinically diagnosed and 14/31 culture-diagnosed children. Of the 17 culture-diagnosed children not started on treatment, 4 were subsequently diagnosed on clinical grounds and treated at clinic level, 8 were found in good health, 4 failed to follow-up and 1 neonate died before the culture result was known. Conclusions: In symptomatic children, the vast majority could be confidently diagnosed on clinical grounds. However, culture-confirmation remains valuable to establish drug susceptibility. © 2006 The British Infection Society.
Description
Keywords
tuberculostatic agent, article, bacterium culture, child, childhood disease, clinical feature, controlled study, delayed diagnosis, diagnostic procedure, diagnostic value, drug sensitivity, extrapulmonary tuberculosis, female, follow up, health status, hospital admission, hospital physician, human, information processing, lung tuberculosis, major clinical study, male, Mycobacterium tuberculosis, newborn death, outcomes research, retrospective study, South Africa, tuberculosis, Child, Child, Preschool, Enzyme-Linked Immunosorbent Assay, Female, Humans, Infant, Infant, Newborn, Laboratory Techniques and Procedures, Male, Medical Records, Polymerase Chain Reaction, Retrospective Studies, South Africa, Time Factors, Tuberculosis, Pulmonary
Citation
Journal of Infection
53
6
53
6