RESUMO
INTRODUCTION: This study evaluates the performance of individual and combinations tests used for pediatric tuberculosis diagnosis at a reference center. MATERIALS AND METHODS: Diagnostic test outcomes from children with presumed pulmonary tuberculosis evaluated from January 2005 - July 2010 were compared to a standard diagnosis made by an expert panel of physicians. RESULTS: Presence of at least one sign/symptom, history of contact, or abnormal chest X-ray (aCXR) individually showed the highest sensitivity (85.7%). While the combination of history of contact, at least one sign/symptom, positive tuberculin skin test, and aCXR had low sensitivity of 20%, but the specificity and a positive predictive value were 100%, respectively. The combination of tests used in the International Union Against Tuberculosis and Lung Disease and the Brazilian Ministry of Health systems showed sensitivity of 28.6% and 71.4% and specificity of 95.8% and 97.0%, respectively. CONCLUSIONS: In the absence of a gold standard, the combination of clinical history, tuberculin skin test, and aCXR, as well as the Brazilian scoring system serve as simple, low-cost approach that can be used for pediatric TB diagnosis by first-contact care providers.
Assuntos
Tuberculose Pulmonar , Tuberculose , Adolescente , Criança , Testes Diagnósticos de Rotina , Humanos , Valor Preditivo dos Testes , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
Key measures to halt the spread of tuberculosis (TB) include early diagnosis, effective treatment, and monitoring disease management. We sought to evaluate the use of serum immunoglobulin levels against antigens present in cell envelope of Mycobacterium tuberculosis to monitor TB treatment response in children and adolescents with pulmonary (PTB) or extrapulmonary TB (EPTB). Blood samples were collected prior to and one, two, and six months following treatment initiation. Serum immunoglobulin levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein were measured by ELISA. Serum from 53 TB patients and 12 healthy participants were analyzed. After six months of successful treatment, there was a significant decrease (p < 0.0001) in IgM levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein and IgG levels against Mce1A protein when compared to baseline immunoglobulin levels. There was no significant variation in antibody levels during follow-up between participants with PTB and EPTB, confirmed and unconfirmed TB diagnosis, and HIV infection status. Antibody levels in control participants without TB did not decrease during follow-up. These results suggest that immunoglobulin responses to mycobacterial cell wall products may be a useful tool to monitor treatment response in children and adolescents with PTB or EPTB.
Assuntos
Antituberculosos/uso terapêutico , Monitoramento de Medicamentos , Ensaio de Imunoadsorção Enzimática , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Fatores Etários , Proteínas de Bactérias/imunologia , Biomarcadores/sangue , Cardiolipinas/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mycobacterium tuberculosis/imunologia , Ácidos Micólicos/imunologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sulfoglicoesfingolipídeos/imunologia , Fatores de Tempo , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/microbiologiaAssuntos
Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/imunologia , Imunoglobulina G/sangue , Tuberculose Latente/diagnóstico , Mycobacterium tuberculosis/imunologia , Testes Sorológicos , Tuberculose Pulmonar/diagnóstico , Adolescente , Fatores Etários , Biomarcadores/sangue , Brasil , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Tuberculose Latente/sangue , Tuberculose Latente/imunologia , Tuberculose Latente/microbiologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/microbiologiaRESUMO
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.