[Diagnosis of tuberculosis in children in provinces of Argentina]

Confirming the diagnosis of pediatric tuberculosis is cumbersome, due to the clinical features (generally paucibacillary forms) of the disease. This national study was undertaken in order to establish: the features of childhood tuberculosis at the time of diagnosis, the criteria on which the pediatricians based the diagnosis, the bacteriologic contribution to the diagnosis and the quality of notifications to the National Programme. Medical and laboratory records were reviewed for children under 15 years of age who were diagnosed with tuberculosis disease or primary infection during 1995. The study included children cared for at health centres from Argentinean provinces (capital city excluded) where pediatricians accepted to participate. Four hundred cases (17% of childhood notifications to the National Programme) and 81 primary infections were studied. The percentage of children studied by means of chest radiology, presence of symptoms, Mantoux test, case contact investigation and bacteriology were 95.3%, 79.6%, 90.1%, 92.7% and 35% for pulmonary cases, respectively, and 87.7%, 100%, 87.7%, 85.9% and 78.9% for extra-pulmonary cases, respectively. Of the evaluated pulmonary cases, 99.1% had abnormal x-rays, 79.0% had a tuberculin test > or = 10 mm, 79.8% had symptoms and 80.2% had a history of close contact. All extra-pulmonary patients had symptoms at the time of diagnosis; 63.0% had abnormal chest radiograph at diagnosis. Bacteriologic confirmation was achieved in 10.7% of the cases (20.8% and 40.0% of the investigated pulmonary and extra-pulmonary cases, respectively). This study would indicate that the diagnosis is made at relatively early stages of the disease. In general, recommendations of the Argentine Society of Pediatrics were followed. A low rate of bacteriological proof of diagnosis was observed, probably due to the scarce bacteriologic investigation and the low yield achieved in culturing pulmonary specimens. The study found under-register of cases and lack of precision in the information reaching the National Programme.