Tuberculosis score chart signs and symptoms in children with positive tuberculin skin tests

Main Article Content

Finny Fitry Yani
Rizanda Machmoed
Marhefdison Marhefdison
Darfioes Basir

Abstract

Background The Indonesian Pediatrics Respirology Working
Group (IPRWG) developed the tuberculosis (TB) score
chart to assist in diagnosing TB in community health centers
(Puskesmas).
Objectives To document signs and symptoms of the IPRWG TB
score chart, to analyze various combinations of these signs and
symptoms, and to compare these combinations in children with
TB to those without TB, based on a TB score chart.
Methods We performed a cross-sectional study from July to
October 2008, in Padang, Bukittinggi and Pasaman. We recruited
children with known positive tuberculin skin tests (TST) from a
2006 tuberculin survey. Questionnaires on signs and symptoms
(IPRWG TB score chart) were completed and chest radiographs
were obtained for all children. Subjects fulfilling a total score of
six or more were considered to have a diagnosis of TB.
Results We diagnosed TB in 78/285 (27.3%) subjects. A score
value of3 for the category of household contact (HHC) positive
smears was added in 21/78 subjects. However, the highest risk for
TB disease was found in those diagnosed with no clear history of
HHC (58.9%; OR 192, 95% CI 22 to 1679). The highest risk
factors for TB were suggestive chest X-ray (34.6%; OR 9.2, 95%
CI 3.6 to 23 .4) and fever lasting > 2 weeks (17.9%; OR 8, 95%
CI 2.2 to 29.1), respectively. Of 46 children with TB diagnosis
but without HHC, the combination of undernourishment, lymph
node enlargement and suggestive chest X-ray was highest (28.2%).
Individual or dual combination signs and symptoms were also
found in children without TB diagnosis.
Conclusion Various combinations of signs and symptoms could
lead to fulfillment of scoring for TB diagnosis. [Paediatr lndones.
2012;5 2: 78-85].

Article Details

How to Cite
1.
Yani F, Machmoed R, Marhefdison M, Basir D. Tuberculosis score chart signs and symptoms in children with positive tuberculin skin tests. PI [Internet]. 30Apr.2012 [cited 15Aug.2020];52(2):78-5. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/323
Section
Articles
Received 2016-08-22
Accepted 2016-08-22
Published 2012-04-30

References

1. Nelson LJ, Wells CD. Global epidemiology of childhood
tuberculosis. Int J Tuberc Lung Dis. 2004;8:636-47.
2. Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC,
Nelson LJ, et al. The clinical epidemiology of childhood
pulmonary tuberculosis: a critical review of literature
from the pre-chemotherapy area. Int J Tubec Lung Dis.
2004;8:278-285.
3. Yantri E, Yani FF, Basir D, Machmoed RM. Prevalensi
sakit tuberculosis pada anak usia 6-7 tahun di kota Padang [master's thesis]. [Padang, Indonesia]: Andalas University
Medical School; 2008.
4. Osborne CM. The challenge of diagnosing childhood
tuberculosis in a developing country. Arch Dis Child.
1995;72:369-74.
5. Rigouts L. Diagnosis of childhood tuberculosis. Eur J Pediatr.
2009; 168: 1285-90.
6. Eamranond P, Jaramillo E. Tuberculosis in children:
reassessing the need for improved diagnosis in global
strategies. Int J Tuberc Lung Dis. 2001;5 :594-603.
7. Swingler GH, Toit G, Andronikou S, Merwe L, Zar HJ.
Diagnostic accuracy of chest radiography in detecting
mediastinal lymphadenopathy in suspected pulmonary
tuberculosis. Arch Dis Child. 2005;90:1153-6.
8. Eisenberg RL, Romero J, Litmanovich D, Boiselle PM,
Bankier AA. Tuberculosis: value oflateral chest radiography
in pre-employment screening of patients with positive
purified protein derivative skin test results. Radiology.
2009;252:882-7.
9. Schaaf HS, Marais BJ, Whitelaw A, Hesseling A, Eley B, Hussey
GD, et al. Culture-confirmed childhood tuberculosis in Cape
Town, South Africa: a review of 596 cases. BMC Infectious
Diseases [serial online]. 2007 [cited 2011 Jan 8]; 7: 140. Available
from: htrp://www.biomedcentral.com/1471-2334/7/140
10. Marais BJ, Gie RP, Schaaf S, Beyers N, Donald PR, Starke
JR. Childhood pulmonary tuberculosis: old wisdom and new
challenge. AmJ Respir Crit Care Med. 2006;173: 1078-90.
11. Nicol MP, Zar HJ. New specimens and laboratory diagnostics
for childhood pulmonary TB: progress and prospects. Paediatr
Respir Rev. 2011;12:16-21.
12. Marais BJ, Gie RP, Hesseling AC, Schaaf HS, Lombard C,
Enarson DA, et al. A refined symptom-based approach to
diagnose pulmonary tuberculosis in children. Pediatrics.
2006; 118:el350-9.
13. Marais BJ, Obihara CC, Gie RP, Schaaf HS, Hesseling
AC, Lombard C, et al. The prevalence of symptoms
associated with pulmonary tuberculosis in randomly selected
children from a high burden community. Arch Dis Child.
2005;90:1166-70.
14. Fourie PB, Becker PJ, Festenstein F, Migliori GB, Alcaide
J, Antunes M, et al. Procedures for developing a simple
scoring method based on unsophisticated criteria for
screening children for tuberculosis. Int J Tuberc Lung Dis.
1998;2:116-23.
15. Marais BJ, Gie RP, Obihara CC, Hesseling AC, Schaaf
HS, Beyers N. Well-defined symptoms are of value in the
diagnosis of childhood pulmonary tuberculosis. Arch Dis
Child. 2005;90:1162-5.
16. Rahajoe NN, Basir D, Makmuri MS, Kartasasmita CB.
Pedoman Nasional Tuberkulosis Anak. Jakarta: Badan
Penerbit IDAI; 2008. p. 93-100.
17. Sie P2TB Dinas Kesehatan Provinsi Sumatera Barat. Profit
Kesehatan Sumatera Barat tahun 2008. p. 20. Draft report.
Padang: Indonesian Government Publishing Service; 2008.
18. Miller FJW, Seal RME, Taylor MD. Tuberculosis in children.
London: J and A Churchill Ltd; 1963. p. 79-163.
19. Singh M, Mynak ML, Kumar L, Mathew JL, Jindal SK.
Prevalence and risk factors for transmission of infection
among children in household contact with adults having
pulmonary tuberculosis. Arch Dis Child. 2005;90:624-8.