ORIGINAL ARTICLE

Well defined symptoms are of value in the diagnosis of childhood pulmonary tuberculosis

B J Marais, R P Gie, C C Obihara, A C Hesseling, H S Schaaf, N Beyers

Desmond Tutu TB Centre and the Department of Paediatrics and Child Health, Tygerberg Children’s Hospital and the Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa

Correspondence to:
Dr B J Marais
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa; bjmarais{at}sun.ac.za

Background: The diagnosis of childhood pulmonary tuberculosis presents a major challenge as symptoms traditionally associated with tuberculosis are extremely common in children from endemic areas. The natural history of tuberculosis in children shows that progressive disease is associated with symptoms which have a persistent, non-remitting character. The aims of this study were to investigate whether improved symptom definition is possible in a clinical setting, and whether use of these well defined symptoms has improved value in the diagnosis of childhood pulmonary tuberculosis.

Methods: A prospective, community based study was conducted in two suburbs of Cape Town, South Africa. All children (<13 years) presenting to the local community clinic with a cough of >2 weeks duration, were referred to the investigator. Parents completed a symptom based questionnaire, whereafter reported symptoms were characterised in a standard fashion.

Results: Of the 151 children enrolled, 21 (15.6%) reported symptoms with a persistent, non-remitting character. Tuberculosis was diagnosed in 16 (10.5%) children, all of whom reported these symptom characteristics. A persistent, non-remitting cough was reported in 15/16 (93.8%) children with tuberculosis and in 2/135 (1.5%) children without tuberculosis, indicating a specificity of 98.5% (135/137). Persistent fatigue of recent onset was also sensitive (13/16, 81.3%) and specific (134/135, 99.3%). Persistent fever and/or chest pain were exclusively reported in children with tuberculosis, but were present in only 4/16 (25.0%) children with tuberculosis.

Conclusion: The use of well defined symptoms is feasible, even in resource limited settings, and may offer significantly improved value in the diagnosis of childhood pulmonary tuberculosis.

Abbreviations: CXR, chest radiograph; PCR, polymerase chain reaction; TST, tuberculin skin test

Keywords: childhood tuberculosis; cough; diagnosis; fatigue; persistent symptoms

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Atoms

Howard Bauchner
Arch. Dis. Child. 2005 90: 1101. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Kruk, A., Gie, R. P., Schaaf, H. S., Marais, B. J. (2008). Symptom-Based Screening of Child Tuberculosis Contacts: Improved Feasibility in Resource-Limited Settings. Pediatrics 121: e1646-e1652 [Abstract] [Full Text]  
• Shields, M D, Bush, A, Everard, M L, McKenzie, S, Primhak, R, on behalf of the British Thoracic Society Cough Gu, (2008). Recommendations for the assessment and management of cough in children. Thorax 63: iii1-iii15 [Full Text]  
• Marais, B. J, Pai, M. (2007). Recent advances in the diagnosis of childhood tuberculosis. Arch. Dis. Child. 92: 446-452 [Abstract] [Full Text]  
• Marais, B. J., Gie, R. P., Hesseling, A. C., Schaaf, H. S., Lombard, C., Enarson, D. A., Beyers, N. (2006). A Refined Symptom-Based Approach to Diagnose Pulmonary Tuberculosis in Children. Pediatrics 118: e1350-e1359 [Abstract] [Full Text]  
• Marais, B. J., Gie, R. P., Schaaf, H. S., Beyers, N., Donald, P. R., Starke, J. R. (2006). Childhood Pulmonary Tuberculosis: Old Wisdom and New Challenges. Am. J. Respir. Crit. Care Med. 173: 1078-1090 [Abstract] [Full Text]  
• Marais, B J (2006). Intrathoracic tuberculosis in children. EDUCATION AND PRACTICE 91: ep1-ep1 [Full Text]