title: Assessment of children exposed to adult pulmonary tuberculosis in Cali, Colombia.
abstract: BACKGROUND
  There is a lack of uniform criteria for the diagnosis and management of tuberculosis (TB) in children in Cali, Colombia. Addressing TB in children is a challenge in this setting, under both programmatic and research conditions.
  
  
  OBJECTIVE
  To facilitate the diagnostic assessment of TB in a paediatric cohort of TB household contacts.
  
  
  METHODS
  A diagnostic and management algorithm (DMA) was used to assess children exposed to adult TB cases, according to clinical and epidemiological findings and under programmatic conditions. On the basis of diagnostic tests, cases were classified as TB exposure, TB infection, suspected TB, possible TB or confirmed TB and then submitted to a management plan. This was a prospective pilot study nested within a national cohort study of the transmission dynamics of Mycobacterium tuberculosis, undertaken in Colombia during 2005-2008.
  
  
  RESULTS
  During 24 months of follow-up, 54 of 217 children met the criteria for assessment by DMA, 18 of whom (33%) were considered to be TB incident cases (new TB cases among household contacts). The main clinical findings were failure to thrive and cough lasting >21 days. Only one case was smear-positive and culture-confirmed TB. TB treatment was given to 16 children and they demonstrated clinical and radiographic resolution at follow-up. Conducting the study under programmatic conditions demonstrated barriers to accessing competent radiological evaluation, correct interpretation of the tuberculin skin test, and proper specimen collection.
  
  
  CONCLUSIONS
  Structured assessment using DMA facilitated the detection of incident TB cases. The study identified potential barriers to addressing childhood TB in Cali.
authors.forename: S L
authors.initials: SL
authors.lastname: Villegas
authors.forename: B E
authors.initials: BE
authors.lastname: Ferro
authors.forename: C M
authors.initials: CM
authors.lastname: Rojas
authors.forename: C M
authors.initials: CM
authors.lastname: Perez-Velez
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003105:Colombia; D003695:Delivery of Health Care / Q000458:organization & administration*; D005192:Family Health; D006801:Humans; D007231:Infant, Newborn; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000635:transmission
chemical_list: D000995:Antitubercular Agents
keywords: Active case-finding,; Childhood tuberculosis,; Diagnostic classification,; Household contacts; Tuberculosis diagnosis,; Tuberculosis in children,; Tuberculosis spectrum,; Tuberculosis treatment,