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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*

The Pediatric Infectious Disease Journal: March 2006 - Volume 25 - Issue 3 - p 237-240
doi: 10.1097/01.inf.0000202140.76368.74
Original Studies

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.

From the *Desmond Tutu TB Centre and the Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa; and the †International Union Against Tuberculosis and Lung Disease, Paris, France

Accepted for publication October 28, 2005.

Supported by Astra Zeneca, the Medical Research Council of South Africa and the United States Agency for Aid and International Development for funding the principal investigator.

The study was in partial fulfillment of a PhD dissertation.

Address for reprints: Dr B. J. Marais, Department of Paediatrics and Child Health, Desmond Tutu TB Center, Faculty of Health Sciences, Stellenbosch University, P.O. Box 19063, Tygerberg, 7505, South Africa. Fax 27-21-838 9138; E-mail

© 2006 Lippincott Williams & Wilkins, Inc.