Evaluation of latent class analysis and decision thresholds to guide the diagnosis of pediatric tuberculosis in a Rwandan reference hospital.
METHODS
A pediatric ward of a university hospital in Kigali, Rwanda, a region with a high HIV seroprevalence.


OBJECTIVE
To estimate the diagnostic accuracy of symptoms, signs, and paraclinical investigations for tuberculosis in children, and to propose a clinical rule based on the results.


METHODS
During a 2-year period all children with cough for more than 2 weeks and/or fever for more than 2 weeks and/or reported weight loss were prospectively included. A set of clinical and paraclinical data were analyzed with latent class analysis. Comparison of post-test probability based on this analysis with a therapeutic threshold for TB was used to develop a guideline.


RESULTS
In the 309 children HIV prevalence was 56%, bacteriology was positive in 9%, and the tuberculin skin test (TST) was >10 mm in 20%. TB prevalence was 32%. Bacteriology and TST had a specificity of 97% and cough had a sensitivity of 91%. Decision analysis suggests treating children presenting one of the inclusion criteria, combined with positive bacteriology or TST >10 mm or contact with a TB patient.


CONCLUSIONS
Latent class analysis confirmed earlier identified predictors for TB and allowed development of an easy to use clinical rule, applicable in reference hospitals of countries with high HIV endemicity.
Tuyisenge
Lisine
L
Service de Pédiatrie, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.
Ndimubanzi
C Patrick
CP
Ndayisaba
Gilles
G
Muganga
Narcisse
N
Menten
Joris
J
Boelaert
Marleen
M
Van den Ende
Jef
J
D002648:Child; D002675:Child, Preschool; D003371:Cough; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D012432:Rwanda; D012680:Sensitivity and Specificity; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology