RT Journal Article
SR Electronic
T1 How do we diagnose tuberculosis in early childhood?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2601
VO 40
IS Suppl 56
A1 Inês Ladeira
A1 Ana Correia
A1 Isabel Carvalho
A1 Aurora Carvalho
A1 Raquel Duarte
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P2601.abstract
AB Children are a special group when considering Tuberculosis(TB)diagnosis:they can develop disease quickly after primary infection,present severe forms and there is a lack of standardized case definition and difficulties in establishing a definitive diagnosisAims: Understand reasons to initiate TB treatment in children under 6 years old(6y) and identify risk factors associated with treatmet in the absence of laboratory criteriaMethods: We reviewed TB records of patients younger than 6y reported in Northern Portugal in 2000-09.Epidemiological,clinical,radiological,microbiological and treatment information were analyzed (univariate/multivariate analysis) using SPSS19.0(p<0.05)Results: In the last 10years 132 children under 6y were diagnosed with TB,60%male.Six children had co-morbidities:five HIV-positive and one diabetic.90%were BCG vaccinated.Information about TB detection known in 130:104 had symptoms(78.8%) and 26 were screened during contact investigation(19.7%).Laboratory criteria for TB obtained in 73(56.2%):31culture-positive(23.7%).Having normal x-ray(OR4.73,CI 1.45-15.45),positive tuberculin skin test-TST(OR5.26,CI 1.92-14.29) and not having performed invasive tests-bronchoscopy/gastric fluid analysis(OR5.95, 1.89-18.67) were independently related to the decision to treat without laboratory criteria.History of TB contact,existence of symptoms and co-morbidities were not associated to that decisionConclusion: Our confirmation rate among this age group was higher than in Europe(19% in 2009).Decision to treat was neither based on laboratory criteria nor on radiological finding consistent with TB,but on a positive TST.Criteria to initiate treatment in this group must be reviewed in order to prevent loosing cases and over-treatment.