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Comparative Study
. 2017 Jun:59:150-155.
doi: 10.1016/j.ijid.2017.01.038. Epub 2017 Apr 25.

A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro, Brazil

Solange Gonçalves David  1 , Kathryn L Lovero  2 , Maria de Fátima B Pombo March  3 , Thalita G Abreu  3 , Antonio Ruffino Netto  4 , Afranio L Kritski  5 , Clemax C Sant'Anna  3 ; Rede-TB Study Group
Affiliations
Comparative Study

A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro, Brazil

Solange Gonçalves David et al. Int J Infect Dis. 2017 Jun.

Abstract

Objectives: The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study.

Methods: A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians.

Results: Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses.

Conclusions: In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.

Keywords: Pediatric TB; TB scoring systems; TB–HIV co-infection.

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Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart of the steps for inclusion in the study groups: 175 HIV-infected pediatric patients evaluated for TB were initially considered for the study. Forty-four were excluded due to loss to follow-up, incomplete or missing records, or change in diagnosis. Of the remaining 131 patients, 83 had been diagnosed as TB cases and 48 as not TB cases by the patients’ attending physicians. After review, the panel of experts excluded 10 cases and came to a different diagnostic conclusion for nine patients, resulting in 64 subjects in group A and 57 in group B.
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References

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    1. Ministério da Saúde. Protocolo clínico e diretrizes terapêuticas para manejo da infecção pelo HIV em crianças e adolescentes. Brazil: Ministry of Health; 2014.

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