title: A critical look at the diagnostic value of culture-confirmation in childhood tuberculosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Engelbrecht
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
authors.forename: Peter R
authors.initials: PR
authors.lastname: Donald
authors.forename: H Simon
authors.initials: HS
authors.lastname: Schaaf
mesh_terms: D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology