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Comparing Treatment Outcomes between Confirmed and Non-Confirmed Childhood TB Cases: Study from a Major Tertiary
Puttichart Khantee1, Kamolwish Laoprasopwattana1
1Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Insights
Diagnosing childhood tuberculosis (TB) is difficult. This study found similar successful treatment outcomes for confirmed, probable, and presumptive TB cases in children, highlighting the need for active contact tracing.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Childhood tuberculosis (TB) diagnosis is complex due to non-specific symptoms and challenges in laboratory confirmation.
- Accurate diagnosis is crucial for effective treatment and management of pediatric TB cases.
Purpose of the Study:
- To compare treatment outcomes between confirmed and non-confirmed tuberculosis cases in children.
- To evaluate the diagnostic categories and their impact on pediatric TB management.
Main Methods:
- Retrospective analysis of medical records of children (≤15 years) diagnosed with TB between 2007-2018.
- Classification of TB cases into confirmed (microbiological evidence), probable (histopathology/AFB), and presumptive (clinical/imaging/response to treatment) groups.
Main Results:
- Out of 177 children, 37.3% had confirmed TB, 32.2% probable, and 30.5% presumptive.
- Successful treatment rates were 80.3% (confirmed), 87.7% (probable), and 92.6% (presumptive), with no significant difference (p=0.21).
- Presumptive cases were less likely to have disseminated/miliary TB (1.9%) compared to confirmed cases (22.7%).
Conclusions:
- A significant proportion of childhood TB cases lack microbiological confirmation.
- Treatment outcomes and mortality rates did not significantly differ across diagnostic categories.
- Active TB contact investigations in households are recommended to improve early detection rates in children.
Background:
Tuberculosis (TB) in children is challenging to diagnose due to its non-specific symptoms and difficulties in obtaining confirmatory laboratory results. This study aimed to compare the treatment outcomes of confirmed and non-confirmed TB in children.
Methods:
The medical records of children aged ≤ 15 years diagnosed with TB at Songklanagarind Hospital from January 2007 to December 2018 were examined. The TB cases were classified into three groups, confirmed cases (positive culture and/or polymerase chain reaction), probable cases (positive histopathological and/or acid-fast bacilli results) and presumptive cases (clinical manifestations and imaging findings compatible with TB and good response to anti-TB drugs but without microbiological confirmation).
Results:
Of 177 children, 66 (37.3%) had a confirmed diagnosis, 57 (32.2%) a probable diagnosis, and 54 (30.5%) a presumptive diagnosis. The successful treatment rates of the confirmed, probable and presumptive TB groups were 80.3%, 87.7% and 92.6%, respectively (p = 0.21). Of the 54 presumptive cases, a history of household contact with TB led to a diagnosis of asymptomatic pulmonary TB in 10 (18.5%) cases. Patients with a presumptive diagnosis were less likely to have disseminated and/or miliary TB (1.9% vs. 7.0% of probable vs. 22.7% of confirmed, p < 0.01).
Conclusions:
Only one-third of the study patients had a confirmed TB diagnosis. The successful treatment and mortality rates did not significantly differ among the three groups. To increase the detection rate of early diagnosis of childhood TB, physicians should perform active TB contact investigations in household members of the index case.