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Pediatric Infectious Disease Journal:
doi: 10.1097/01.inf.0000202140.76368.74
Original Studies

Radiographic Signs and Symptoms in Children Treated for Tuberculosis: Possible Implications for Symptom-Based Screening in Resource-Limited Settings

Marais, Ben J. MRCP(Paed UK), FCP(Paed SA), MMed(Paed)*; Gie, Robert P. FCP(Paed SA)*; Hesseling, Anneke C. MBChB, MSc*; Schaaf, H Simon MMed(Paed), MD(Paed)*; Enarson, Donald A. MD†; Beyers, Nulda FCP(Paed SA), MSc, PhD*

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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.

© 2006 Lippincott Williams & Wilkins, Inc.

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