Revista Portuguesa de Pneumologia Revista Portuguesa de Pneumologia
Rev Port Pneumol 2017;23:317-22 - Vol. 23 Num.6 DOI: 10.1016/j.rppnen.2017.06.004
Original article
Tuberculosis in children from diagnosis to decision to treat
S. Ramosa,, , R. Gaiob, F. Ferreirac, J. Paulo Leald, S. Martinse, J. Vasco Santosf,g, I. Carvalhoh,i, R. Duarteh,i,j
a Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
b Departamento de Matemática, Faculdade de Ciências da Universidade do Porto & Centro de Matemática da Universidade do Porto, Rua do Campo Alegre, Porto, Portugal
c Departamento de Matemática, Faculdade de Ciências da Universidade do Porto, Rua do Campo Alegre, Porto, Portugal
d CRACS & INESC-Porto LA, Faculty of Sciences, University of Porto, Rua do Campo Alegre, Porto, Portugal
e USF do Mar, ACeS Grande Porto IV - Póvoa de Varzim/Vila do Conde, Rua José Moreira de Amorim, Póvoa de Varzim, Portugal
f Department of Community Medicine, Informatics and Decision in Health (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
g Center for Health Technology and Services Research (CINTESIS), Alameda Prof. Hernâni Monteiro, Porto, Portugal
h Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, Portugal
i ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, Porto, Portugal
j Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
Received 28 March 2017, Accepted 25 June 2017
Abstract
Setting

Confirmation of tuberculosis (TB) in children is difficult, so clinicians use different procedures when deciding to treat.

Objective

Identify criteria to initiate and maintain TB treatment in children younger than 5 years-old, without diagnosis confirmation.

Design

A web-based survey was distributed by email to the corresponding authors of journal articles on childhood TB. The observations were clustered into disjoint groups, and analyzed by Ward's method.

Results

We sent out 260 questionnaires and received 64 (24.6%) responses. Forty-six respondents (71.9%) said that microbiological confirmation was not important for initiation of anti-TB treatment, and that the epidemiological context and signs/symptoms suggestive of disease were most important. Sixty-one respondents (95.3%) said that the decision to continue therapy was mainly dependent on clinical improvement. A cluster of older respondents (median age: 52 years-old) who were active at a hospital or primary health care centre placed the most value on immunological test results and chest X-rays. A cluster of younger respondents (median age: 38 years-old) who were less experienced in management of TB placed more value on Interferon Gamma Release Assay (IGRA) results and chest computed tomography (CT) scans. A cluster of respondents with more experience in treating TB and working at specialized TB centres placed greater value on the clinical results and specific radiological alterations (“tree-in-bud” pattern and pleural effusion).

Conclusion

TB management varied according to the age, work location and experience of the clinicians. It is necessary to establish standardized guidelines used for the diagnosis and decision to treat TB in children.

Keywords
Tuberculosis, Paediatric, Childhood, Mycobacterium tuberculosis, Treatment
Rev Port Pneumol 2017;23:317-22 - Vol. 23 Num.6 DOI: 10.1016/j.rppnen.2017.06.004