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The diagnosis of pulmonary tuberculosis in malnourished Kenyan children
Insights
Diagnosing childhood pulmonary tuberculosis (TB) is challenging. A proposed diagnostic approach considers factors like malnutrition and recent measles, especially in young children with suspected TB.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diagnostic guidelines for childhood pulmonary tuberculosis (TB) lack consistency.
- High TB prevalence areas face difficulties in confirming pediatric TB diagnoses.
- Existing diagnostic methods show limitations in young, malnourished populations.
Purpose of the Study:
- To evaluate diagnostic methods for pulmonary tuberculosis in children.
- To propose an improved diagnostic process for pediatric TB in high-prevalence settings.
- To address challenges in TB diagnosis among young, malnourished children.
Main Methods:
- Prospective study of 144 children diagnosed with pulmonary TB.
- Recording of diagnostic methods used for each child.
- Analysis of diagnostic criteria including tuberculin response, family contact, and chest radiography.
Main Results:
- Only 6 out of 144 children had bacteriologically confirmed TB.
- 75 children had probable TB based on clinical and radiological findings.
- Suspected TB cases were younger, had delayed treatment, and higher mortality (30%) compared to probable TB cases (8%).
Conclusions:
- A significant proportion of young, malnourished children do not respond to tuberculin tests.
- A trial of anti-tuberculous therapy is a valid diagnostic tool for suspected pediatric TB in specific vulnerable groups.
- The proposed diagnostic strategy aims to improve TB confirmation and management in children.
Abstract:
Guidelines available for the diagnosis of pulmonary tuberculosis (TB) in children vary widely. In an area of high prevalence, pulmonary TB was often suspected but difficult to confirm. In a prospective study, diagnostic methods were recorded in 144 consecutive children admitted and diagnosed as having pulmonary TB. Six of the 144 children had bacteriologically confirmed tuberculosis. Seventy-five children had probable tuberculosis, the diagnosis being based on the tuberculin response in 19, a history of family contact in 34 and a diagnostic chest radiograph in 22. The remaining 63 children had suspected tuberculosis: 23 of these had an inconclusive chest X-ray. The suspected group were significantly younger than the probable group (mean ages 2.8 and 4.4 years respectively), experienced a longer delay between admission and the start of antituberculous chemotherapy and suffered a significantly higher mortality (30% and 8% respectively). A diagnostic process is proposed which takes account of the high proportion of nonresponders to tuberculin in a young, malnourished population. A trial of anti-tuberculous therapy is accepted as a valid diagnostic manoeuvre in suspected cases who are malnourished or have recently had measles.