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Proposal of an improved score method for the diagnosis of pulmonary tuberculosis in childhood in developing countries
G B Migliori1, A Borghesi, P Rossanigo
1Department of Pneumology, Tradate Medical Centre, Italy.
Insights
Gastric washing is highly effective for diagnosing pulmonary tuberculosis (PTB) in children under five, showing high sensitivity and specificity. A modified score method using gastric washing is proposed for resource-limited settings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Pulmonary tuberculosis (PTB) diagnosis in children under five presents challenges, particularly in resource-limited settings.
- Accurate and accessible diagnostic tools are crucial for effective PTB management in pediatric populations.
Purpose of the Study:
- To evaluate the diagnostic accuracy of gastric washing for PTB in children under five.
- To assess the contribution of other diagnostic methods like Mantoux test and chest X-ray.
- To propose a modified diagnostic score method suitable for developing countries.
Main Methods:
- A study involving 210 children under five suspected of PTB at Arua Regional TB Centre, Uganda.
- Diagnostic procedures included anamnesis, clinical examination, Mantoux test, gastric washing, and chest X-ray.
- A score method was used for diagnosis, and response to treatment was evaluated.
Main Results:
- Gastric washing demonstrated high diagnostic accuracy: 96.8% sensitivity, 92.2% specificity, 68.2% positive predictive value, and 99.4% negative predictive value.
- Alcohol acid-fast bacilli (AAFB) were detected in 30 out of 31 confirmed PTB cases via gastric lavage.
- Mantoux test and chest X-ray provided minor diagnostic contributions compared to gastric washing.
Conclusions:
- Gastric washing is a highly sensitive and specific method for diagnosing PTB in young children.
- A modified score method incorporating gastric washing and treatment response is proposed for improved PTB diagnosis in resource-limited areas.
- The proposed method addresses the lack of advanced facilities like chest X-ray in developing countries.
Abstract:
210 children aged less than 5 years, referred to the Arua Regional TB Centre (Uganda) for suspected pulmonary tuberculosis (PTB), were examined by anamnesis, clinical examination, Mantoux test, gastric washing, chest X-ray. The response to treatment criterion was applied to the patients treated. According to the score method suggested by Ghidey and Habte, 31 children were diagnosed as PTB patients. 30 of the 31 children with PTB tested positive for alcohol acid-fast bacilli (AAFB) in the aspirated juice. The Mantoux test and X-rays gave a minor contribution to diagnosis. The clinical results are commented. A statistical analysis was carried out to evaluate the role of gastric washing in the diagnosis of PTB in children under 5 years of age (sensitivity, 96.8%; specificity, 92.2%; positive predictive value, 68.2%; negative predictive value, 99.4%). The response to treatment was also evaluated. A modified enlarged score method (based on gastric washing and including response to treatment) is proposed to be applied in developing countries where chest X-ray and other facilities are often lacking.