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Title: Evaluation of new strategies for the diagnosis of tuberculosis among pediatric contacts of tuberculosis patients
Authors: Perez-Porcuna, T. M.
Ascaso Terrén, Carlos
Ogusku, Maurício Morishi
Abellana, R.
Malheiro, Adriana
Quincó, Patrícia
Antunes, Irineide Assumpção
Monte, Rossicléia Lins
Tavares, Michel
Garrido, Marlúcia Silva
Bührer-Sékula, Samira
Martínez-Espinosa, Flor Ernestina
Keywords: Bcg Vaccine
Bacterium Culture
Bcg Vaccination
Clinical Classification
Clinical Protocol
Controlled Study
Diagnostic Test
Early Diagnosis
Laboratory Diagnosis
Liquid Culture
Lung Tuberculosis
Major Clinical Study
Mycobacteria Growth Indicator Tube
Mycobacterium Tuberculosis
Nasopharyngeal Aspiration
Nutritional Status
Outpatient Care
Polymerase Chain Reaction
Child, Preschool
Priority Journal
Scoring System
Sensitivity And Specificity
Sputum Analysis
Sputum Smear
Thorax Radiography
Tuberculin Test
Chi-square Distribution
Child, Preschool
Contact Tracing
Roc Curve
Tuberculin Test
Issue Date: 2012
metadata.dc.publisher.journal: Pediatric Infectious Disease Journal
metadata.dc.relation.ispartof: Volume 31, Número 9, Pags. e141-e146
Abstract: Background: In young children, underdiagnosis and diagnostic delay have an adverse effect on morbidity and mortality of tuberculosis (TB). This study evaluated new strategies for early TB diagnosis using an outpatient protocol in children between 0 and 5 years of age, with a recent household TB contact. Methods: Case recruitment was performed in Manaus, Amazonas, Brazil, from 2008 to 2009. Epidemiologic and clinical data, tuberculin test, chest radiograph and 2 induced sputum respiratory samples from each participant were obtained. Laboratory diagnosis was based on Lowenstein-Jensen (LJ) culture, mycobacteria growth indicator tube (MGIT) and polymerase chain reaction. We conducted a study of comparison of diagnostic tests and a study of cases and controls to identify the clinical characteristics of the population with positive culture and polymerase chain reaction results. Results: A total of 102 children were evaluated. Thirty-two fulfilled criteria of suspicion of TB. MGIT was more sensitive (P = 0.035) and faster (P < 0.001) than LJ. Clinical score, MGIT, LJ and polymerase chain reaction presented no concordance or slight concordance. A positive MGIT culture was only associated with a strong tuberculin test reaction (P = 0.026). The combination of MGIT with the clinical score allowed the diagnosis of 33% more cases with little or no symptomatology compared with the exclusive use of the clinical classification. Conclusions: The sensitivity and speed of MGIT demonstrate the utility of liquid cultures for the diagnosis in children. Furthermore, these results suggest that the use of MGIT in children presenting recent household TB contact and a strong tuberculin test reaction may be a strategy to improve early TB diagnosis. © 2012 by Lippincott Williams and Wilkins.
metadata.dc.identifier.doi: 10.1097/INF.0b013e31825cbb3b
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