Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 1, Number 4—October 1995

Diagnosis of Tuberculosis in Children: Increased Need for Better Methods

Ejaz A. Khan and Jeffrey R. StarkeComments to Author 
Author affiliations: Baylor College of Medicine, Houston, Texas, USA

Main Article

Table 3

A set of criteria for the diagnosis of pulmonary tuberculosis (TB) in children when culture is not available

A. Positive acid-fast stain of sputum or gastric aspirate
B. Two or more of the following:
History of contact with a tuberculous adult
Cough lasting longer than 2 weeks
A reactive tuberculin skin test > or = 10 mm in children without prior BCG vaccination > or = 15 mm in children with prior BCG vaccination
Radiographic findings compatible with TB
Response to anti-TB therapy (increased body weight by 10% after 2 months, decrease in symptoms)
Source: ref. 33.

Main Article

  1. Starke  JR, Correa  AG. Management of mycobacterial infection and disease in children. Pediatr Infect Dis J. 1995;14:45570. DOIPubMedGoogle Scholar
  2. Styblo  K, Rouillon  A. Tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Against Tuber Lung Dis. 1990;65:624.
  3. Starke  JR, Jacobs  R, Jereb  J. Resurgence of tuberculosis in children. J Pediatr. 1992;120:83955. DOIPubMedGoogle Scholar
  4. Cantwell  M, Snider  D Jr, Cauthen  G, Onorato  I. Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA. 1994;272:5359. DOIPubMedGoogle Scholar
  5. Kochi  A. The global tuberculosis situation and the new control strategy of the World Health Organization. Tuber Lung Dis. 1991;72:16.
  6. Raviglione  MC, Snider  DE, Kochi  A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA. 1995;273:2206. DOIPubMedGoogle Scholar
  7. Dolin  P, Raviglione  M, Kochi  A. Global tuberculosis incidence and mortality during 1990-2000. Bull World Health Organ. 1994;72:21320.PubMedGoogle Scholar
  8. Barnes  PF, Borrows  SA. Tuberculosis in the 1990s. Ann Intern Med. 1993;119:40010.PubMedGoogle Scholar
  9. Hsu  KHK. Contact investigation: a practical approach to tuberculosis eradication. Am J Public Health. 1963;53:17619. DOIGoogle Scholar
  10. Nolan  RJ Jr. Childhood tuberculosis in North Carolina: a study of the opportunities for intervention in the transmission of tuberculosis to children. Am J Public Health. 1986;76:2630. DOIPubMedGoogle Scholar
  11. Brailey  ME. Tuberculosis in white and negro children. II. The epidemiologic aspects of the Harriet Lane study. Cambridge, MA: Harvard University Press, 1958.
  12. Steiner  P, Rao  M, Victoria  MS, Persistently negative tuberculin reactions: their presence among children culture positive for M. tuberculosis. Am J Dis Child. 1980;134:74750.PubMedGoogle Scholar
  13. Starke  JR, Taylor-Watts  KT. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics. 1989;84:2835.PubMedGoogle Scholar
  14. Vallejo  J, Ong  LT, Starke  JR. Clinical features, diagnosis and treatment of tuberculosis in infants. Pediatrics. 1994;94:17.PubMedGoogle Scholar
  15. Lifschitz  M. The value of the tuberculin skin test as a screening test for tuberculosis among BCG-vaccinated children. Pediatrics. 1965;36:6247.PubMedGoogle Scholar
  16. Landi  S, Ashley  MJ, Grzybowski  S. Tuberculin sensitivity following the intradermal and puncture methods of BCG vaccination. Can Med Assoc J. 1967;97:2225.PubMedGoogle Scholar
  17. Joncas  JH, Robitaille  R, Gauthier  T. Interpretation of the PPD skin test in BCG-vaccinated children. Can Med Assoc J. 1975;113:1278.PubMedGoogle Scholar
  18. Johnson  H, Lee  B, Kelly  E, McDonnell  T. Tuberculin sensitivity and the BCG scar in tuberculosis contacts. Tuber Lung Dis. 1995;35:1137.
  19. Menzies  R, Vissandjee  B. Effect of bacille Calmette-Guerin vaccination on tuberculin reactivity. Am Rev Respir Dis. 1992;141:6215.
  20. Sepulveda  RL, Burr  C, Ferrer  X, Sorensen  RU. Booster effect of tuberculin testing in healthy 6-year-old school children vaccinated with bacille Calmette-Guerin at birth in Santiago, Chile. Pediatr Infect Dis J. 1988;7:57882. DOIPubMedGoogle Scholar
  21. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis. 1990;142:72535.PubMedGoogle Scholar
  22. American Academy of Pediatrics Committee on Infectious Diseases. Screening for tuberculosis in infants and children. Pediatrics. 1994;93:1314.PubMedGoogle Scholar
  23. Schaaf  HS, Beyers  N, Gie  RP, Respiratory tuberculosis in childhood: the diagnostic value of clinical features and special investigations. Pediatr Infect Dis J. 1995;14:18994. DOIPubMedGoogle Scholar
  24. Parisi  MT, Jensen  MC, Wood  BP. Pictorial review of the usual and unusual roentgen manifestations of childhood tuberculosis. Clin Imaging. 1994;18:14954. DOIPubMedGoogle Scholar
  25. Delacourt  C, Mani  TM, Bonnerot  V, Computed tomography with normal chest radiograph in tuberculous infection. Arch Dis Child. 1993;69:4302. DOIPubMedGoogle Scholar
  26. Strumpf  IJ, Tsang  AY, Syre  JW. Reevaluation of sputum staining for the diagnosis of pulmonary tuberculosis. Am Rev Respir Dis. 1979;119:599602.PubMedGoogle Scholar
  27. Lipsky  BA, Bates  J, Tenover  FC, Plorde  JJ. Factors affecting the clinical value of microscopy for acid-fast bacilli. Rev Infect Dis. 1984;6:21422.PubMedGoogle Scholar
  28. Kent  PT, Kubica  GP. Public health mycobacteriology a guide for the level III laboratory. Atlanta, GA; Centers for Disease Control, 1985.
  29. Abadco  DL, Steiner  P. Gastric lavage is better than bronchioalveolar lavage for isolation of Mycobacterium tuberculosis in childhood tuberculosis. Pediatr Infect Dis J. 1992;11:7358. DOIPubMedGoogle Scholar
  30. Carr  DT, Karlson  AG, Stillwell  AA. A comparison of cultures of induced sputum and gastric washings in the diagnosis of tuberculosis. Mayo Clin Proc. 1967;42:235.PubMedGoogle Scholar
  31. Chan  S, Abadco  DL, Steiner  P. Role of flexible fiberoptic bronchoscopy in the diagnosis of childhood endobronchial tuberculosis. Pediatr Infect Dis J. 1994;13:5069.PubMedGoogle Scholar
  32. Glidey  Y, Hable  D. Tuberculosis in childhood: an analysis of 412 cases. Ethiop Med J. 1983;21:1617.PubMedGoogle Scholar
  33. Migliori  AB, Borghesi  A, Rossanigo  P, Proposal for an improved score method for the diagnosis of pulmonary tuberculosis in childhood in developing countries. Tuber Lung Dis. 1992;73:1459. DOIPubMedGoogle Scholar
  34. Schluger  NW, Rom  WN. Current approaches to the diagnosis of active pulmonary tuberculosis. Am J Respir Crit Care Med. 1994;149:2647.PubMedGoogle Scholar
  35. Eisenach  KD, Sifford  MD, Cane  MD, Bates  JH, Crawford  JT. Detection of Mycobacterium tuberculosis in sputum samples using a polymerase chain reaction. Am Rev Respir Dis. 1991;144:11603.PubMedGoogle Scholar
  36. Noordhock  A, Kolk  A, Bjune  G, Sensitivity and specificity of polymerase chain reaction for detection of Mycobacterium tuberculosis: a blind comparison study among seven laboratories. J Clin Microbiol. 1994;32:27784.PubMedGoogle Scholar
  37. Pierre  C, Oliver  C, Lecossier  D, Bousssougant  Y, Yemi  P, Hance  AJ. Diagnosis of primary tuberculosis in children by amplification and detection of mycobacterial DNA. Am Rev Respir Dis. 1993;147:4204.PubMedGoogle Scholar
  38. Starke  JR, Ong  LT, Eisenach  KD, Detection of M. tuberculosis in gastric aspirate samples from children using polymerase chain reaction. Am Rev Respir Dis. 1993;147(Suppl):A801.
  39. Delacourt  C, Poveda  J-D, Churean  C, Use of polymerase chain reaction for improved diagnosis of tuberculosis in children. J Pediatr. 1995;126:7039. DOIPubMedGoogle Scholar
  40. Rosen  EU. The diagnostic value of an enzyme-linked immunosorbent assay using adsorbed mycobacterial sonicates in children. Tubercle. 1990;71:12730. DOIPubMedGoogle Scholar
  41. Barrera  L, Miceli  I, Ritacco  V, Detection of circulating antibodies to purified protein derivative by enzyme-linked immunosorbent assay: its potential for the rapid diagnosis of tuberculosis. Pediatr Infect Dis J. 1989;8:7637. DOIPubMedGoogle Scholar
  42. Hussey  G, Kibel  M, Dempster  W. The serodiagnosis of tuberculosis in children: an evaluation of an ELISA test using IgG antibodies to M. tuberculosis, strain H37RV. Ann Trop Paediatr. 1991;11:1138.PubMedGoogle Scholar
  43. Delacourt  C, Gobin  J, Gaillard  J-L, de Blic  J, Veran  M, Scheinmann  P. Value of ELISA using antigen 60 for the diagnosis of tuberculosis in children. Chest. 1993;104:3938. DOIPubMedGoogle Scholar
  44. Turneer  M, Nerom  EV, Nyabenda  J, Waelbroeck  A, Duvivier  A, Toppet  M. Determination of humoral immunoglobulins M and G directed against mycobacterial antigen 60 failed to diagnose primary tuberculosis and mycobacterial adenitis in children. Am J Respir Crit Care Med. 1994;150:150812.PubMedGoogle Scholar
  45. Sada  E, Ruiz-Palacios  AM, Lopez-Vidal  Y, Detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis by enzyme-linked immunosorbent assay. Lancet. 1983;2:6512. DOIPubMedGoogle Scholar
  46. Radhakrishnan  VV, Sehgal  S, Mathai  A. Correlation between culture of Mycobacterium tuberculosis and detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis. J Med Microbiol. 1990;33:2236. DOIPubMedGoogle Scholar
  47. Wadee  AA, Boling  L, Reddy  SG. Antigen capture assay for detection of a 43-kilodalton Mycobacterium tuberculosis antigen. J Clin Microbiol. 1990;28:278691.PubMedGoogle Scholar
  48. Sada  E, Aguilar  D, Torres  M, Detection of lipoarabinomannan as a diagnostic test for tuberculosis. J Clin Microbiol. 1992;30:24158.PubMedGoogle Scholar
  49. Brooks  JB, Daneshvar  MI, Fast  DM, Selective procedures for detecting femtomole quantities of tuberculostearic acid in serum and cerebrospinal fluid by frequency-pulsed electron-capture gas-liquid chromatograph. J Clin Microbiol. 1987;25:12016.PubMedGoogle Scholar
  50. Brooks  JB, Daneshvar  MI, Harberger  RL, Rapid diagnosis of tuberculous meningitis by frequency-pulsed electron-captive gas-liquid chromatography detection of carboxylic acids in cerebrospinal fluid. J Clin Microbiol. 1990;28:98997.PubMedGoogle Scholar
  51. Centers for Disease Control and Prevention. National action plan to combat multidrug-resistant tuberculosis. MMWR. 1992;41:550.
  52. Bloch  AB, Cauthen  GM, Onorato  IM, Nationwide survey of drug-resistant tuberculosis in the United States. JAMA. 1994;271:66571. DOIPubMedGoogle Scholar

Main Article

Page created: December 20, 2010
Page updated: December 20, 2010
Page reviewed: December 20, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.