RESPIRATORY TUBERCULOSIS IN CHILDHOOD - THE DIAGNOSTIC-VALUE OF CLINICAL-FEATURES AND SPECIAL INVESTIGATIONS

During a 16-month period children presenting to a pediatric outpatient facility from an area with a high tuberculosis incidence (>400/100 00 0) and suspected of having respiratory tuberculosis (TB) were evaluate d for close contact with adult pulmonary tuberculosis, weight loss, sy mptom duration, respiratory signs, lymphadenopathy and hepatosplenomeg aly and by chest radiography and tuberculin testing (Mantoux or tine). Probable tuberculosis was diagnosed in 258 children and was confirmed in 109 (42%) patients with a mean age of 31 months by culture of Myco bacterium tuberculosis from gastric aspirate or another source. Eleven children with confirmed TB had a normal chest radiograph. After revie w of special investigations, clinical course and follow-up of the rema ining 149 children, 86 children (58%) with a mean age of 32.4 months w ere considered to have probable TB and 63 (42%) with a mean age of 27 months not to have TB. Significantly fewer children in the ''not TB'' group than in the confirmed and probable TB groups had a close adult p ulmonary tuberculosis contact (13 (21%) and 95 (49%), respectively; P < 0.01). There was no difference between the ''not TB'' group and the confirmed and probable TB groups in the proportion presenting with wei ght loss, cough or other respiratory symptoms, a symptom duration >2 w eeks, the presence of bronchial breathing, wheeze, hepatomegaly or spl enomegaly or peripheral lymphadenopathy. Final diagnoses in the ''not TB'' group included bacterial or viral pneumonia or bronchopneumonia i n 37, asthma often accompanied by segmental collapse in 9 and cavitati ng pneumonia in 3 children. On the one hand children in whom there wer e sufficient criteria to be considered probable cases of TB were subse quently thought not to have TB; on the other hand 11 (10%) of children with TB confirmed by culture of Mycobacterium tuberculosis from gastr ic aspirate had a normal chest radiograph.