The Use of Diagnostic Systems for Tuberculosis in Children

Abstract

Effective management of tuberculosis (TB) in children and important data of disease burden continue to rely on a clinical approach to diagnosis, as diagnosis of childhood TB is not confirmed in the majority. Many diagnostic scoring systems have been developed to aid with diagnosis. This article reviews the use and evaluation of these approaches. The diagnostic systems are often closely related and all rely on the well-known clinical features associated with TB disease in children. The scoring systems are not well validated and validation is limited by the lack of a gold standard for comparison. When they have been validated, some systems perform reasonably well but may bias to identify the most obvious clinical cases. They perform less well in important sub-groups that pose the greatest diagnostic challenge and are at greatest risk for poor outcome, such as the young, malnourished or HIV-infected. There is marked variation in performance between these diagnostic approaches. The better validated systems may have a role as a screening tool in some settings, but this would need careful consideration as to the most useful and safest approach. More attention is being given to improving diagnosis and management of child TB, including within National TB Programmes. Research with new diagnostics should include children so that there is less reliance on clinical features alone. However, the clinical approach will continue to be relevant and so it is important to strive to improve the diagnostic approach to TB in children, and to validate the approach in different settings.

Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis in children: A prospective, multi-centre evaluation

“…6 In the absence of bacteriological confirmation the diagnosis of childhood TB is usually based on non-specific and subjective markers such as clinical symptoms, TB contact history, chest radiograph findings and tuberculin skin test (TST); often in combination with clinical scoring charts which have poor diagnostic accuracy. 7 Consequently, there is an urgent need to identify a practical, affordable, reliable and fast way to diagnose TB in children.…”

Understanding NIH clinical case definitions for pediatric intrathoracic TB by applying them to a clinical trial

“…A number of papers highlight difficulties in comparing results across studies. 13,14,15,16 Whether the NIH definitions can be broadened to be applicable to settings of clinical research with active surveillance requiring it to capture a wide spectrum of TB disease requires expert consideration.…”

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul

“…( 8 , 9 ) Although their validation is limited by the lack of a gold standard for comparison, these systems have played an important role in diagnostic screening. ( 10 ) Diagnostic, clinical, and radiological criteria, as well as TST results, are still recommended, given that, in the short term, there is little prospect of devising a standard diagnostic method, which involves culture, microscopy, PCR, or serological tests, widely available to children. ( 11 ) Since 2002, the Brazilian National Ministry of Health (NMH) has officially recommended a scoring system for the diagnosis of pulmonary tuberculosis in smear-negative children and adolescents.…”