Radiographic signs and symptoms in children treated for tuberculosis: possible implications for symptom-based screening in resource-limited settings.
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.
Marais
Ben J
BJ
Desmond Tutu TB Centre and the Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa. bjmarais@sun.ac.za
Gie
Robert P
RP
Hesseling
Anneke C
AC
Schaaf
H Simon
HS
Enarson
Donald A
DA
Beyers
Nulda
N
D000995:Antitubercular Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D016358:Contact Tracing; D005260:Female; D006295:Health Resources / Q000191:economics*; D006801:Humans; D008297:Male; D008403:Mass Screening; D011859:Radiography; D013019:South Africa; D014374:Tuberculin Test; D014376:Tuberculosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology
D000995:Antitubercular Agents