Houwert K A, Borggreven P A, Schaaf H S, Nel E, Donald P R, Stolk J
Dept of Pulmonology, Leiden University Medical Center, The Netherlands.
Eur Respir J. 1998 May;11(5):1116-20. doi: 10.1183/09031936.98.11051116.
Because of the difficulty in confirming childhood tuberculosis (TB), the World Health Organization (WHO) proposes a hierarchical approach to diagnosis using history and certain clinical features to help to improve the control of TB in communities. The objective of this study was to evaluate prospectively in children the diagnostic value of recent weight loss or failure to gain weight adequately, cough or wheezing for >2 weeks and recent household contact with an adult case of pulmonary TB. These evaluations were performed in 627 children presenting to the paediatric outpatient department of a tertiary hospital situated in the Western Cape Province of South Africa and serving a community with a very high incidence of TB (>1,000 per 100,000). If at least one of the criteria was present, the diagnosis of TB was investigated further by clinical investigation, Mantoux test, chest radiography and TB culture from gastric aspirate. One or more of the proposed criteria for diagnosing TB in childhood were present in 206 children (33%). TB confirmed by culture of Mycobacterium tuberculosis from gastric aspirate was found in 10 children (5%). After diagnostic work-up, 23 children (11%) were considered to have probable TB, whereas 173 (84%) were, after follow-up of 8 weeks, thought not to have TB. In this study the simultaneous presence of the three WHO criteria for suspecting TB had a positive predictive value of 63%. These results should assist in the more precise delineation of the predictive value of the proposed World Health Organization approach to the diagnosis of tuberculosis in childhood.
由于确诊儿童结核病存在困难，世界卫生组织（WHO）提出了一种分级诊断方法，利用病史和某些临床特征来帮助改善社区结核病的控制。本研究的目的是前瞻性评估近期体重减轻或体重增加不足、咳嗽或喘息超过2周以及近期与成年肺结核患者有家庭接触史对儿童结核病的诊断价值。这些评估在南非西开普省一家三级医院儿科门诊就诊的627名儿童中进行，该社区结核病发病率非常高（每10万人中超过1000例）。如果至少存在一项标准，则通过临床检查、结核菌素试验、胸部X线检查和胃抽吸物结核培养进一步调查结核病诊断。206名儿童（33%）存在一项或多项儿童结核病诊断标准。通过胃抽吸物结核分枝杆菌培养确诊的结核病患儿有10名（5%）。经过诊断检查，23名儿童（11%）被认为可能患有结核病，而在8周随访后，173名儿童（84%）被认为没有结核病。在本研究中，同时存在世界卫生组织怀疑结核病的三项标准时，阳性预测值为63%。这些结果应有助于更精确地描述世界卫生组织提出的儿童结核病诊断方法的预测价值。
