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Screening asymptomatic children for pulmonary TB: to X-ray or not to X-ray?

Screening asymptomatic children for pulmonary TB: to X-ray or not to X-ray?
Screening asymptomatic children for pulmonary TB: to X-ray or not to X-ray?
Objective: recent studies found that a chest x-ray (CXR) has limited value in the assessment of asymptomatic adults with tuberculosis (TB) infection. We aimed to determine in asymptomatic children with a positive tuberculin skin test and/or interferon-? release assay (TST/IGRA) whether a CXR identifies findings suggestive of pulmonary TB.

Design, setting and patients: all children with TB infection (defined as TST ?10?mm and/or positive IGRA) presenting to The Royal Children's Hospital Melbourne during a 54-month period were included. All CXRs were reviewed by a senior radiologist blinded to the clinical details. The medical records of those with radiological abnormalities suggestive of TB were examined to identify those who were asymptomatic when the CXR was done. Demographical data were also collected.

Results: CXRs were available for 268 of 330 TB-infected children, of whom 60 had CXR findings suggestive of TB. Of the 57 for whom clinical details were available, 26 were asymptomatic. Of these asymptomatic children with radiological abnormalities suggestive of TB, 6 had CXR findings suggestive of active TB, 14 had CXR findings suggestive of prior TB and 6 had isolated non-calcified hilar lymphadenopathy. The six with findings suggestive of active TB represented 2.6% (95% CI 0.9 to 5.5%) of asymptomatic TST/IGRA-positive children with evaluable CXRs. One child with isolated hilar lymphadenopathy had microbiologically-confirmed TB.

Conclusions: in contrast to the results from studies in adults, a CXR identified a small but noteworthy number of children with findings suggestive of pulmonary TB in the absence of clinical symptoms
0003-9888
401-404
Gwee, A.
163aedc5-aabf-4eef-b540-b3a510b6d7db
Pantazidou, A.
72cf8be4-5c01-4a73-87db-68d4089175b0
Ritz, N.
01953c34-5267-4807-8f93-1c6973f7d57c
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Connell, T.G.
5535c7a7-38cc-48db-a48e-aaad185b5d3d
Cain, T.
4390e647-c681-4727-9304-3107f54ea6a5
Curtis, Nathan
de97bba8-0c86-4f07-a6c2-dbdfd96958c8
Gwee, A.
163aedc5-aabf-4eef-b540-b3a510b6d7db
Pantazidou, A.
72cf8be4-5c01-4a73-87db-68d4089175b0
Ritz, N.
01953c34-5267-4807-8f93-1c6973f7d57c
Tebruegge, Marc
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Connell, T.G.
5535c7a7-38cc-48db-a48e-aaad185b5d3d
Cain, T.
4390e647-c681-4727-9304-3107f54ea6a5
Curtis, Nathan
de97bba8-0c86-4f07-a6c2-dbdfd96958c8

Gwee, A., Pantazidou, A., Ritz, N., Tebruegge, Marc, Connell, T.G., Cain, T. and Curtis, Nathan (2013) Screening asymptomatic children for pulmonary TB: to X-ray or not to X-ray? Archives of Disease in Childhood, 98 (6), 401-404. (doi:10.1136/archdischild-2013-303672). (PMID:23606714)

Record type: Article

Abstract

Objective: recent studies found that a chest x-ray (CXR) has limited value in the assessment of asymptomatic adults with tuberculosis (TB) infection. We aimed to determine in asymptomatic children with a positive tuberculin skin test and/or interferon-? release assay (TST/IGRA) whether a CXR identifies findings suggestive of pulmonary TB.

Design, setting and patients: all children with TB infection (defined as TST ?10?mm and/or positive IGRA) presenting to The Royal Children's Hospital Melbourne during a 54-month period were included. All CXRs were reviewed by a senior radiologist blinded to the clinical details. The medical records of those with radiological abnormalities suggestive of TB were examined to identify those who were asymptomatic when the CXR was done. Demographical data were also collected.

Results: CXRs were available for 268 of 330 TB-infected children, of whom 60 had CXR findings suggestive of TB. Of the 57 for whom clinical details were available, 26 were asymptomatic. Of these asymptomatic children with radiological abnormalities suggestive of TB, 6 had CXR findings suggestive of active TB, 14 had CXR findings suggestive of prior TB and 6 had isolated non-calcified hilar lymphadenopathy. The six with findings suggestive of active TB represented 2.6% (95% CI 0.9 to 5.5%) of asymptomatic TST/IGRA-positive children with evaluable CXRs. One child with isolated hilar lymphadenopathy had microbiologically-confirmed TB.

Conclusions: in contrast to the results from studies in adults, a CXR identified a small but noteworthy number of children with findings suggestive of pulmonary TB in the absence of clinical symptoms

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Published date: 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 350871
URI: http://eprints.soton.ac.uk/id/eprint/350871
ISSN: 0003-9888
PURE UUID: 90777d0c-c117-4908-93c8-09cc7379b0cd

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Date deposited: 25 Apr 2014 07:42
Last modified: 16 Jul 2019 21:38

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Contributors

Author: A. Gwee
Author: A. Pantazidou
Author: N. Ritz
Author: Marc Tebruegge
Author: T.G. Connell
Author: T. Cain
Author: Nathan Curtis

University divisions

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