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Tuberculosis Diagnosis in HIV-Infected Children: Comparison of the 2012 and 2015 Clinical Case Definitions for
Olivier Marcy1,2, Sophie Goyet1, Laurence Borand1
1Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
Insights
The 2015 tuberculosis diagnostic criteria for children identified more cases than the 2012 version, showing substantial agreement. Spontaneous symptom resolution is key for accurate pediatric tuberculosis diagnosis.
Area of Science:
- Pediatric infectious diseases
- Global health
- Clinical diagnostics
Background:
- No definitive gold standard exists for diagnosing childhood tuberculosis.
- International experts developed Clinical Case Definitions for intrathoracic tuberculosis in children in 2012 and updated them in 2015.
- This study compares the 2012 and 2015 definitions in HIV-infected children with suspected tuberculosis.
Purpose of the Study:
- To compare the diagnostic performance of the 2012 and 2015 Clinical Case Definitions for intrathoracic tuberculosis.
- To evaluate the agreement between the two versions of the case definition in HIV-infected children.
- To assess the impact of the updated definition on tuberculosis classification in this vulnerable population.
Main Methods:
- The study enrolled HIV-infected children with suspected tuberculosis across Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS 12229 PAANTHER 01 Study).
- Children were classified using both the 2012 and 2015 Case Definitions.
- Agreement between the classifications was statistically assessed using the kappa statistic.
Main Results:
- Out of 438 children, 197 (45.0%) were classified as tuberculosis by the 2012 definition, while 251 (57.3%) were classified by the 2015 definition.
- Inter-classification agreement was substantial at 83.1% (kappa = 0.667).
- Of children classified as probable tuberculosis by the 2012 definition, 93.4% were considered tuberculosis by the 2015 version; 43.9% of those classified as possible tuberculosis in 2012 were reclassified as tuberculosis in 2015.
Conclusions:
- The 2015 Clinical Case Definition identified more children with tuberculosis than the 2012 version, with substantial agreement between the two.
- Spontaneous symptom resolution in some children supports the "unlikely tuberculosis" classification and highlights the importance of clinical judgment.
- The updated 2015 definition may improve case detection in HIV-infected children with suspected tuberculosis.
Background:
There is no gold standard for tuberculosis diagnosis in children. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children were proposed by international experts in 2012 and updated in 2015. We aimed to compare the 2012 and 2015 Clinical Case Definitions in HIV-infected children with suspected tuberculosis.
Methods:
We enrolled HIV-infected children with suspected tuberculosis in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS [Agence Nationale de Recherches sur le SIDA et les hépatites virales] 12229 PAANTHER [Pediatric Asian African Network for Tuberculosis and HIV Research] 01 Study). We classified children using the 2012 and 2015 Case Definitions considering as tuberculosis cases those with confirmed tuberculosis and those with probable and unconfirmed tuberculosis in the 2012 and the 2015 classifications, respectively. We assessed agreement between both classifications.
Results:
Of 438 children enrolled, 197 (45.0%) children were classified as tuberculosis (45 confirmed, 152 probable) using the 2012 Case Definition and 251 (57.3%) were classified as tuberculosis (55 confirmed, 196 unconfirmed) using the 2015 classification. Inter-classification agreement for tuberculosis diagnosis was 364/438, 83.1%, with a kappa statistic of 0.667 (95% confidence interval 0.598-0.736). Of 152 children with probable tuberculosis (2012), 142 (93.4%) were considered as tuberculosis by the 2015 version and 10 (6.6%) as unlikely tuberculosis including 9 with spontaneous clinical improvement. Of 132 possible tuberculosis (2012), 58 (43.9%) were reclassified as tuberculosis (2015).
Conclusions:
Agreement between the 2 versions of the Case Definition was substantial but more children were considered as tuberculosis using the 2015 version. Spontaneous symptom resolution reinforces both confidence in the "unlikely" category as being children without tuberculosis and the importance of the clinician's treatment decision in the study.
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