Diagnosis of pulmonary tuberculosis in young children.

The Stop TB Strategy encompasses promotion and support for childhood TB including diagnosis. The diagnosis of TB in low-income countries needs to be improved using existing technology. All hospitals involved in managing children with TB should have a regular stock of tuberculin. A chest radiograph (CXR) is an integral part of the diagnosis of pulmonary TB and hospitals should be able to take satisfactory CXRs of young children. If there is a reliable laboratory service, bacterial confirmation should be undertaken in selected cases. The laboratory should be able to deal satisfactorily with paediatric specimens. Gastric aspiration is the method of choice to obtain sputum from young children and generally produces higher yields than other methods, and, with good technique, results in outpatients may not be much lower than in inpatients. Nasopharyngeal aspiration is a simple alternative method requiring limited equipment. Sputum induction requires a special room, capital and recurrent equipment and a dedicated nurse. Laryngeal swabs are suitable for older outpatients unable to produce adequate sputum. Each hospital should have a clinician trained in the diagnosis and management of childhood TB, including the interpretation of CXRs and skill in fine-needle aspiration. Radiologists and clinicians should use a simple, clear, internationally accepted classification of paediatric CXRs. The clinician(s) in charge of TB services should oversee all inpatients with TB and be at the forefront in running the TB clinic. A TB nurse specialist(s) should be part of the team. There is now a will to improve the diagnosis and management of childhood TB but bringing it to fruition requires efforts by the local TB service, paediatricians, radiology departments and laboratory services.