Solange Gonçalves David1, Kathryn L Lovero2, Maria de Fátima B Pombo March3, Thalita G Abreu3, Antonio Ruffino Netto4, Afranio L Kritski5, Clemax C Sant'Anna3. 1. Hospital Municipal Jesus, Rio de Janeiro, Brazil; Clinical Medicine Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 2. Division of Infectious Diseases and Vaccinology, and Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA. Electronic address: katelovero@berkeley.edu. 3. Department of Pediatrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 4. Ribeirão Preto School of Medicine, Federal University of São Paulo, Ribeirão Preto, São Paulo, Brazil. 5. Academic Tuberculosis Program, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Abstract
OBJECTIVES: The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study. METHODS: A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. RESULTS: Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. CONCLUSIONS: In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.
OBJECTIVES: The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infectedpatients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infectedchildren were compared in this study. METHODS: A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatricpatients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. RESULTS: Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. CONCLUSIONS: In HIV-infected pediatricpatients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting.
Authors: Alexander W Kay; Tara Ness; Sabine E Verkuijl; Kerri Viney; Annemieke Brands; Tiziana Masini; Lucia González Fernández; Michael Eisenhut; Anne K Detjen; Anna M Mandalakas; Karen R Steingart; Yemisi Takwoingi Journal: Cochrane Database Syst Rev Date: 2022-09-06
Authors: Bryan Vonasek; Tara Ness; Yemisi Takwoingi; Alexander W Kay; Susanna S van Wyk; Lara Ouellette; Ben J Marais; Karen R Steingart; Anna M Mandalakas Journal: Cochrane Database Syst Rev Date: 2021-06-28
Authors: Alexander W Kay; Lucia González Fernández; Yemisi Takwoingi; Michael Eisenhut; Anne K Detjen; Karen R Steingart; Anna M Mandalakas Journal: Cochrane Database Syst Rev Date: 2020-08-27
Authors: Roberta Feijó Carvalho; Anna Cristina Calçada Carvalho; Luis Guillermo Coca Velarde; Andrea Maciel de Oliveira Rossoni; Rafaela Baroni Aurilio; Selma Maria de Azevedo Sias; Christiane Mello Schmidt; Adriana da Silva Rezende Moreira; Pedro da Silva Martins; Lorrayne Isidoro Gonçalves; Terezinha Miceli Martire; Ana Paula Ferreira Barbosa; Ana Paula Quintanilha Dos Santos; Roberta Maia de Castro Romanelli; Maria das Graças Rodrigues de Oliveira; Lilian Martins Oliveira Diniz; Andrea Lucchesi de Carvalho; Sheila Cunha Lucena; Maria Letícia Santos Cruz; Mariza Curto Saavedra; Tony Tannous Tahan; Cristina de Oliveira Rodrigues; Afrânio Lineu Kritski; Clemax Couto Sant'Anna; Claudete Aparecida Araújo Cardoso; Maria de Fátima Bazhuni Pombo Sant'Anna Journal: Rev Inst Med Trop Sao Paulo Date: 2020-10-30 Impact factor: 1.846