Usefulness of thoracic CT to diagnose tuberculosis disease in patients younger than 4 years of age

Abstract

Background: There is controversy over the need of using thoracic CT (TCT) systematically for differentiating disease from tuberculosis infection in young children. This distinction is important when making a diagnosis of TB as the treatment changes from a single drug to a multidurug regimen with reported side-effects.

Aim: To determine the usefulness of using TCT to diagnose pulmonary tuberculosis (PTB) in patients younger than 4 years of age who have TB infection (IBI).

Materials and methods: After the simultaneous detection of four cases of PTB in children who attended the same class, a study on the contact among workers and children was carried out. One hundred sixteen children younger than 4 years and 20 adults were included. The tuberculin skin test (TST) was performed on all of them. CHEST XR (CXR) and TCT were performed on children with positive TST and three samples of gastric acid were taken. CXR and sputum testing were performed on adults with positive TST.

Results: TST was positive in 28 children (24.1%). In 92.8% of children with positive TST and normal CXR, TCT showed features compatible with PTB. Out of the 28 children with positive TST, 27 (96.4%) were diagnosed with PTB and only one with latent TBI (4%).

Conclusions: In children younger than 4-year old with positive TST and normal CXR, it would be advisable to perform a TCT since the findings could change the diagnosis from TBI to TB disease.