Sant'Anna Clemax Couto, Santos Marilene Augusta R C, Franco Rosana
Martagão Gesteira Puericulture and Pediatrics Institute of the Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2004 Aug;8(4):305-10. doi: 10.1590/s1413-86702004000400006. Epub 2004 Nov 19.
Since 2002, the Brazilian Ministry of Health has recommended a score system for tuberculosis diagnosis of children and adolescents that does not need bacteriological positivity, because most cases in this age group have few bacteria. An observational, transversal study was carried out at the outpatient health care service of the reference medical service in Salvador, Bahia, including 164 patients with pulmonary tuberculosis, with ages ranging between 1 and 15 years of age, who were treated from 1990 to 2001. The gold standard used to establish the diagnosis was clinical, radiological, epidemiological and based on follow-up data. The score system for diagnosis purposes was tested retrospectively. The median age and the average age of the 164 patients were 6 and 6.62 years (SD +/- 4.33), respectively. About 65% of the sample reported a history of close contact with a tuberculous adult. The BCG vaccine coverage was 70.7% (116/164). It was found that 26% (43/164) of the patients had severe malnutrition. Out of this group, 26/43 (60.47%) were < 5 mm reactive to the tuberculin test. On the other hand, out of the 91 patients with tuberculin test < 5 mm, 29% (26/ 91) had severe malnutrition. The use of the score gave the following distribution: a) TB very likely in 81.7% (134/164) of the patients; b) possible TB in 15.9% (26/164) and TB unlikely in 2.4% (4/164). Among patients who had been vaccinated more than 2 years before, there was a 9 times higher risk of finding a tuberculin test above 10 mm in individuals with probable TB in comparison with the patients with possible or unlikely TB.
自2002年以来，巴西卫生部推荐了一种用于儿童和青少年结核病诊断的评分系统，该系统无需细菌学阳性结果，因为该年龄组的大多数病例细菌数量很少。在巴伊亚州萨尔瓦多的参考医疗服务机构的门诊医疗服务中进行了一项观察性横断面研究，纳入了164例肺结核患者，年龄在1至15岁之间，他们在1990年至2001年期间接受治疗。用于确立诊断的金标准是临床、放射学、流行病学以及基于随访数据的标准。对用于诊断目的的评分系统进行了回顾性测试。164例患者的中位年龄和平均年龄分别为6岁和6.62岁（标准差±4.33）。约65%的样本报告有与结核病成人密切接触史。卡介苗接种覆盖率为70.7%（116/164）。发现26%（43/164）的患者患有严重营养不良。在这一组中，26/43（60.47%）对结核菌素试验的反应<5毫米。另一方面，在结核菌素试验<5毫米的91例患者中，29%（26/91）患有严重营养不良。使用该评分得出以下分布：a）81.7%（134/164）的患者极有可能患结核病；b）15.9%（26/164）的患者可能患结核病，2.4%（4/164）的患者患结核病的可能性不大。在接种超过2年的患者中，与可能或不太可能患结核病的患者相比，极有可能患结核病的个体结核菌素试验结果高于10毫米的风险高9倍。
