Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update

Abstract

Consensus case definitions for childhood tuberculosis have been proposed by an international expert panel, aiming to standardize the reporting of cases in research focusing on the diagnosis of intrathoracic tuberculosis in children. These definitions are intended for tuberculosis diagnostic evaluation studies of symptomatic children with clinical suspicion of intrathoracic tuberculosis, and were not intended to predefine inclusion criteria into such studies. Feedback from researchers suggested that further clarification was required and that these case definitions could be further improved. Particular concerns were the perceived complexity and overlap of some case definitions, as well as the potential exclusion of children with acute onset of symptoms or less severe disease. The updated case definitions proposed here incorporate a number of key changes that aim to reduce complexity and improve research performance, while maintaining the original focus on symptomatic children suspected of having intrathoracic tuberculosis. The changes proposed should enhance harmonized classification for intrathoracic tuberculosis disease in children across studies, resulting in greater comparability and the much-needed ability to pool study results.

Keywords: childhood tuberculosis; tuberculosis case definitions; tuberculosis classification; tuberculosis diagnosis.

Figure 1.

Proposed revised algorithm for classification of case definitions for research reporting from diagnostic evaluation studies of intrathoracic tuberculosis in children. Response or no response to antituberculosis therapy is only relevant if antituberculosis therapy was given as determined by clinical indications. A trial of treatment should NOT be used as a diagnostic tool. ^aNote that this does not refer to a positive clinical response without anti-TB therapy, which would be a negative feature for this category. Abbreviations: M.tb, Mycobacterium tuberculosis; TB, tuberculosis.