The possibility of and need for getting definitive diagnosis of tuberculosis in children

Background and objectives A study of tuberculosis in children was undertaken in the outpatient departments of four hospitals in Chennai city by the Tuberculosis Research Centre of the Indian Council for Medical Research. The objective of this partial analysis was to assess the feasibility and usefulness of carrying out investigations in children selected on the basis of symptoms suggestive of TB. Methods 2479 Children were admitted to the study based on symptoms like prolonged or irregular cough or fever, with or without systemic signs. Detailed history was taken and clinical examination was carried out in all children presenting to the outpatient departments. All children were tuberculin tested, and had a chest x-ray. Sputum examination or gastric lavage on two consecutive days was examined for M.TB by culture. Results All the investigations could be done with a coverage of over 90 %. Mantoux was positive in 64 % of the patients, but did not help distinguish those who were more likely to be bacteriologically positive. 61 % of the bacteriology positive children had a normal X-ray. Gastric lavage or sputum were obtained in 99 % of patients; 2.7 % for sputum and 6.8 % for gastric lavage were positive on culture. Conclusions The feasibility of documenting the bacteriology in children with suspected TB was good, and should be attempted in all large centers dealing with TB in children. This would also help to understand the epidemiology of TB in children by ensuring that the reported cases are without doubt cases of tuberculosis.