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Published on: April 9, 2012
A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro,
Solange Gonçalves David1, Kathryn L Lovero2, Maria de Fátima B Pombo March3
1Hospital Municipal Jesus, Rio de Janeiro, Brazil; Clinical Medicine Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Insights
Diagnosing pediatric tuberculosis (TB) in HIV-infected children is challenging. The Tidjani system demonstrated the highest accuracy, while Ben Marais and Ministry of Health systems are useful for screening.
Area of Science:
- Pediatric infectious diseases
- HIV/AIDS research
- Diagnostic accuracy studies
Background:
- Pediatric tuberculosis (TB) diagnosis is complex, especially in HIV-infected children.
- No universally accepted gold standard exists for diagnosing pediatric TB.
- Evaluating existing diagnostic systems is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the diagnostic performance of four established TB diagnostic systems.
- To assess the effectiveness of these systems in HIV-infected pediatric patients.
- To identify optimal diagnostic strategies for pediatric TB in this population.
Main Methods:
- Retrospective cohort study of 121 HIV-infected children evaluated for TB.
- Application and comparison of four diagnostic systems: Kenneth Jones (1969), Tidjani (1986), Ben Marais (2006), and Brazilian Ministry of Health (2010).
- Comparison of system results against a standardized expert panel diagnosis.
Main Results:
- The Tidjani system exhibited the highest diagnostic accuracy, irrespective of microbiological data inclusion.
- Tidjani and Kenneth Jones systems minimized false-positive results.
- Ben Marais and Ministry of Health systems reduced false-negative results.
- Limited agreement was observed between the different TB diagnostic systems.
Conclusions:
- The Ben Marais and Ministry of Health systems are suitable for initial TB diagnostic screening in HIV-infected children.
- The Tidjani and Kenneth Jones systems are best utilized within specialized reference centers.
- Tailoring diagnostic approaches based on system strengths is recommended for pediatric TB management.
Objectives:
The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study.
Methods:
A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians.
Results:
Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses.
Conclusions:
In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.
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