Chisti Mohammod Jobayer, Salam Mohammed Abdus, Shahid Abu S M S B, Shahunja K M, Das Sumon Kumar, Faruque Abu Syed Golam, Bardhan Pradip Kumar, Ahmed Tahmeed
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Glob Pediatr Health. 2017 Jan 19;4:2333794X16686871. doi: 10.1177/2333794X16686871. eCollection 2017.
Evidences on diagnosis of tuberculosis (TB) following the World Health Organization (WHO) criteria in children with severe acute malnutrition (SAM) are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388). However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture-confirmed TB, sensitivity and specificity (95% confidence interval) of WHO criteria were 40 (14% to 73%) and 84 (80% to 87%), respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43%) and 83 (79% to 87%), respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings.
关于按照世界卫生组织（WHO）标准诊断重度急性营养不良（SAM）儿童结核病（TB）的证据不足。我们试图评估WHO标准对此类儿童结核病的诊断价值。在这项前瞻性研究中，我们纳入了年龄小于5岁且患有放射性肺炎的SAM儿童。我们收集诱导痰和洗胃样本用于涂片显微镜检查、分枝杆菌培养及Xpert MTB/RIF检测。以最后两种方法作为金标准，我们确定了WHO标准（n = 388）的敏感性、特异性、阳性预测值和阴性预测值。然而，仅对最后214名儿童进行了Xpert MTB/RIF检测。与分枝杆菌培养确诊的结核病相比，WHO标准的敏感性和特异性（95%置信区间）分别为40（14%至73%）和84（80%至87%）。与培养和/或Xpert MTB/RIF确诊的结核病相比，其值分别为22%（9%至43%）和83（79%至87%）。因此，WHO标准良好的特异性可能有助于减少对SAM儿童过度进行抗结核治疗，尤其是在资源有限的环境中。
