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The use of the paediatric tuberculosis score chart in an HIV-endemic area
1St Theresa's Mission Hospital, Ibenga, Mpongwe District, Copperbelt Province, Zambia. patrick.kajta@planet.net
Insights
The paediatric tuberculosis score chart (TSC) is not reliable for diagnosing tuberculosis (TB) in children with human immunodeficiency virus (HIV) in high-prevalence areas. Its low specificity leads to overdiagnosis and unnecessary treatment.
Area of Science:
- Pediatric infectious diseases
- Global health
- Diagnostic accuracy studies
Background:
- Diagnosing tuberculosis (TB) in children coinfected with human immunodeficiency virus (HIV) presents significant challenges due to overlapping clinical symptoms.
- The paediatric tuberculosis score chart (TSC) is promoted for resource-poor settings but lacks evaluation in high HIV prevalence areas.
Purpose of the Study:
- To evaluate the diagnostic utility of the paediatric tuberculosis score chart (TSC) in an area with a high prevalence of HIV.
Main Methods:
- A prospective cohort study was conducted in Zambia, comparing TSC results against a comprehensive diagnostic algorithm.
- The algorithm included sputum microscopy, culture, PCR for Mycobacterium tuberculosis, tuberculin skin test, chest X-ray, and histology.
Main Results:
- The study enrolled 147 children, categorized by TB and HIV status.
- No significant differences in TB scores were observed between groups.
- The TSC demonstrated a sensitivity of 88% but a low specificity of 25% for diagnosing TB.
Conclusions:
- The TSC is not recommended as a diagnostic tool in HIV-endemic regions due to its low specificity.
- The TSC can lead to overdiagnosis of TB and inappropriate use of antitubercular medications.
- There is an urgent need for improved diagnostic tools for childhood TB in HIV-endemic settings.
Background:
Diagnosing tuberculosis (TB) in a human immunodeficiency virus (HIV)-endemic area is extremely difficult, as the clinical symptoms of HIV-seropositive children can be easily confounded with TB. The paediatric tuberculosis score chart (TSC) was developed for resource-poor countries and its use continues to be promoted despite the fact that this scoring system has not been evaluated in countries with a high HIV prevalence.
Objective:
To assess the utility of the TSC in an HIV-endemic area.
Method:
A prospective cohort study conducted between January and December 1999 at St Theresa's Mission Hospital, Copperbelt Province, Zambia. Results of the TSC (TB score) were compared with the results of a diagnostic algorithm, incorporating sputum smear microscopy, culture and polymerase chain reaction of Mycobacterium tuberculosis, tuberculin skin test, chest X-ray and histology eventually.
Results:
A total of 147 children were enrolled in the study. On the basis of HIV-serology and clinical findings they were divided into four groups: children with TB (23 HIV-seropositive; 52 HIV-seronegative), 21 HIV-infected children without TB and 51 HIV-seronegative children without TB. The differences in TB scores between the groups were not significant. The sensitivity of the TSC to diagnose TB in this study was 88%; but the specificity was only 25%.
Conclusion:
The TSC should not be used as a diagnostic tool in countries with a high HIV prevalence. The low specificity of this scoring system leads to overdiagnosis of TB and unnecessary use of costly, antituberculous drugs. New tools for TB diagnosis in children in HIV-endemic areas are urgently needed.