Comparison of clinical tools for dengue diagnosis in a pediatric population-based cohort.

BACKGROUND: We aimed to estimate and compare the ability of clinical tools for dengue diagnosis in a pediatric population. METHODS: We prospectively evaluated episodes of acute febrile syndrome identified during the follow-up of a population-based cohort of children and adolescents residing in a dengue endemic city. We estimated the area under the receiver operating characteristic curve (AU-ROC) for dengue diagnosis of three clinical tools: the summation of manifestations of the WHO case definition, a predefined clinical scale and a logistic regression model obtained in this study. RESULTS: We compared 219 dengue cases (confirmed by laboratory) and 286 patients with other febrile illnesses. In a multiple model, variables independently associated with dengue included the duration of fever, sleepiness and exanthema. Rhinorrhea, cough and minimal leukocyte count were inversely associated with dengue. This model reached an accuracy of 84.2% (for a cut-off of >0.5, sensitivity: 79.5%, specificity: 87.9%, positive predictive value: 83.7%, negative predictive value: 84.6%). The AU-ROC of this model (89.8%) was significantly higher than that obtained with either the predefined scale (82.1%) or the WHO definition manifestations (77%). CONCLUSION: We validated a predefined scale and identified a multiple model suitable for the clinical diagnosis of dengue in the pediatric population.

The COPD Assessment Test: What Do We Know So Far?: A Systematic Review and Meta-Analysis About Clinical Outcomes Prediction and Classification of Patients Into GOLD Stages.

BACKGROUND: The COPD Assessment Test (CAT) was developed as a simple instrument to assess health status in patients with COPD. This study aimed to systematically review the determinants of the CAT score, its ability to predict clinical outcomes, and the agreement between CAT (≥ 10) and the modified Medical Research Council scale (mMRC ≥ 2) to categorize patients into the new Global Initiative for Chronic Obstructive Lung Disease classification system. METHODS: From January 1, 2009, to June 30, 2015, databases were searched for studies using CAT in adults with COPD and in general populations aiming to detect COPD. Two investigators independently screened, selected, and extracted data by using a standardized form. Where appropriate, the results were combined in a random effects meta-analysis. RESULTS: Of 453 studies, 17 were included, and eight were used in the meta-analysis. The models to predict the CAT score were able to explain < 50% of its variance. CAT scores can indicate risk of exacerbation, depression, acute deterioration in health status, and mortality. All studies found a different proportion of patients in each Global Initiative for Chronic Obstructive Lung Disease category using CAT ≥ 10 or mMRC ≥ 2. On average, the distribution was 13% different according to the instrument used. The κ agreement between CAT and mMRC ranged from 0.13 to 0.77. CONCLUSIONS: CAT may be used as a complementary tool in a patient's clinical assessment to predict COPD exacerbation, health status deterioration, depression, and mortality. The interpretation of this meta-analysis does not support the use of the recommended cutoff points of ≥10 for CAT and ≥2 for mMRC as equivalents for the purpose of assessing patient symptoms.

Measuring the accuracy of a point system to diagnose tuberculosis in children with a negative smear or with no smear or culture.

In Brazil, a scoring system was adopted to diagnose tuberculosis in childhood. This study determined the accuracy in diagnosing tuberculosis in children with either a negative smear or with no smear or culture conducted in a reference center in João Pessoa Paraíba - Brazil. It is a phase III validation study, using a cross-section design. The study population consisted of 167 patients attending the outpatient clinics suspected of having tuberculosis. The reference standard for the diagnosis of tuberculosis was a blind and independent review of the medical records, radiology and tuberculin test by two experts. Of the 167 patients, 60 were considered to have tuberculosis (by the reference standard diagnostics). The results for the scoring system with the cut-off of 30 points were: sensitivity 78.57% (95%-CI: 65.56-88.41%), specificity 69.16% (95%-CI: 59.50-77.73%), positive predictive value (PPV): 57.14% (95%-CI: 45.35-68.37%), negative predictive value (NPV): 86.05% (95%-CI: 76.89-92.58%), likelihood ratio (+): 2,55, pre-test probability: 34.36%, and post-test probability (+): 57.14%. This supports the current recommendation for the use of this scoring system in Brazil and similar sites with the cut-off of 30 points. However, as the discriminatory power of the point scoring system may vary across settings, it would be advisable to replicate this phase III study in different settings.

Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil.

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Quality of spirometry in 5-to-8-year-old children.

INTRODUCTION: Although spirometry quality standards for children were proposed by American Thoracic Society/European Respiratory Society (ATS/ERS) in 2007, there is limited information on the percentage of children that fulfill these criteria during routine clinical testing, especially among 5-to-8-year-olds. AIMS OF THE STUDY: to report the percentage of children that met the current 2007 ATS/ERS quality criteria; explore factors potentially associated with poor quality spirometry; and ascertain the repeatability of forced expiratory volume at 0.5 sec (FEV0.5 ), and at 1 sec (FEV1 ), as well as forced vital capacity (FVC). METHODS: We evaluated the quality of spirometries without bronchodilator use performed at our laboratory in 2008 by 5-to-8-year-old children. FEV1 , FEV0.5 , FVC, back-extrapolated volume (BEV), forced expiratory time (FET), number of acceptable maneuvers, and repeatability, were computed and the percentage of tests that met the quality criteria standards was calculated. Based on our results, we propose a quality scoring system for spirometry for children that grades on a scale from A-to-F. RESULTS: Three hundred seventy-six spirometries were reviewed. Mean age was 6.7 years; (53% males); 68% fulfilled the 2005 and 2007 ATS/ERS quality standards; >90% reached a repeatability ≤150 and ≤100 ml, or 10%, in FVC or FEV1 ; 87.2% reached FET ≥3 sec; 88% had a BEV ≤80 ml. The 90 percentile repeatability was 120 ml for FVC and FEV1 . Quality improved with age. CONCLUSIONS: Our results support the proposal that a FET ≥3 sec, a BEV ≤80 ml, and repeatability in FEV1 and FVC ≤100 ml, or 10%, be taken into account as elements in quality control for spirometry in children.

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul / Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

OBJETIVO: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. MÉTODOS: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. RESULTADOS: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração > 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. CONCLUSÕES: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Evidence of effect of subcutaneous immunotherapy in children: complete and updated review from 2006 onward.

OBJECTIVE: To update the scientific evidence of subcutaneous immunotherapy (SCIT) in children. DATA SOURCES: PubMed, EMBASE, and known articles. STUDY SELECTION: All publications on SCIT in pediatric patients from January 2006 to April 2011. Study design was not a restriction. The articles were analyzed according to their outcomes and evaluated on their scientific quality using the Grading of Recommendations Assessment, Development, and Evaluation and Jadad tools. Clinical, safety, and immunologic data were gathered. RESULTS: The scientific evidence produced by the 31 articles analyzed showed that there is high-quality evidence that grass pollen SCIT causes a reduction in the combined symptom-medication score and increases the threshold of the conjunctival provocation test, immediately and 7 years after termination of SCIT, as well as the threshold of the specific bronchial provocation test and the skin prick test reactivity. Alternaria SCIT improves medication scores, combined symptom-medication scores, and quality of life. It augments the threshold in the nasal provocation test. High-quality evidence of house dust mite SCIT shows that asthma symptom and medication scores improve and emergency department visits and skin reactivity are reduced; moderate evidence indicates improvement in pulmonary function tests. Pollen SCIT prevents asthma (moderate evidence); evidence for long-term benefit of pollen SCIT (7-12 years after termination) is low to moderate. There is inconclusive evidence for SCIT reducing new sensitizations. CONCLUSION: There is acceptable evidence that shows that grass pollen, Alternaria, and house dust mite SCIT is beneficial in allergic children.

Is tuberculosis difficult to diagnose in childhood and adolescence?

OBJECTIVE: To determine the sensitivity of the scoring system proposed by the Brazilian National Ministry of Health in 2002 for the diagnosis of tuberculosis in children and adolescents suspected of having the disease. METHODS: This was a retrospective study of 316 children and adolescents (0-14 years of age) diagnosed with pulmonary tuberculosis between 1997 and 2007 at the Brazilian Institute for Tuberculosis Research, located in the city of Salvador, Brazil. After reviewing the medical charts and chest X-rays of the patients, we calculated the tuberculosis scores. RESULTS: The majority of the subjects (80.4%) had a history of close household contact with an AFB-positive adult within the last two years. The tuberculin test was negative in 11 subjects (3.5%). According to the scoring system, 251 (79.4%) were very likely to have tuberculosis (score, > 40), 63 (19.9%) were moderately likely to have tuberculosis (score, 30-35), and 2 (0.7%) were unlikely to have tuberculosis (score, < 25). When a cut-off score of 30 was used, the sensitivity of this scoring system was 99.3%. CONCLUSIONS: In our sample, the sensitivity of this scoring system was high when the selected cut-off score was employed. If a cut-off score of 40 had been used, 20% of the subjects would not have been treated. Therefore, scores between 30 and 35 are critical for diagnostic confirmation. Judicious clinical evaluation should prevail in the decision of treating these patients. When the cut-off score of 30 is used, 30% of individuals with other pathologies will be treated for tuberculosis. This highlights the need for improved diagnostic methods for tuberculosis.

A tuberculose na infância e na adolescência é difícil de diagnosticar? / Is tuberculosis difficult to diagnose in childhood and adolescence?

OBJETIVO: Determinar a sensibilidade do sistema de escore proposto pelo Ministério da Saúde do Brasil em 2002 para o diagnóstico de crianças e adolescentes com suspeita de tuberculose. MÉTODOS: Entre 1997 e 2007, 316 crianças e adolescentes (0-14 anos de idade) com diagnóstico de tuberculose pulmonar no Instituto Brasileiro de Investigação da Tuberculose, em Salvador (BA), foram incluídos no presente estudo retrospectivo. Foram revisados os prontuários médicos e as radiografias de tórax dos pacientes, e os escores foram calculados. RESULTADOS: A maioria dos sujeitos (80,4 por cento) tinha história de contato domiciliar com adultos com BAAR positivo nos últimos dois anos. O teste tuberculínico foi negativo em 11 sujeitos (3,5 por cento). Conforme o sistema de escore, 251 (79,4 por cento) muito provavelmente tinham tuberculose (escores > 40), 63 (19,9 por cento) possivelmente tinham tuberculose (escores entre 30 e 35) e 2 (0,7 por cento) pouco provavelmente tinham tuberculose (escores < 25). A sensibilidade desse sistema de escore foi de 99,3 por cento, com um ponto de corte de 30. CONCLUSÕES: Em nossa amostra, a sensibilidade do sistema de escore foi alta para o ponto de corte selecionado. Com um ponto de corte de 40, 20 por cento dos sujeitos não teriam sido tratados. Portanto, escores entre 30 e 35 são críticos para a definição diagnóstica. Uma avaliação clínica judiciosa deve prevalecer para a decisão de tratar esses pacientes. Com um ponto de corte de 30, 30 por cento dos indivíduos com outras patologias seriam tratados para tuberculose. Isto enfatiza a necessidade de melhores métodos diagnósticos para a tuberculose.

OBJECTIVE: To determine the sensitivity of the scoring system proposed by the Brazilian National Ministry of Health in 2002 for the diagnosis of tuberculosis in children and adolescents suspected of having the disease. METHODS: This was a retrospective study of 316 children and adolescents (0-14 years of age) diagnosed with pulmonary tuberculosis between 1997 and 2007 at the Brazilian Institute for Tuberculosis Research, located in the city of Salvador, Brazil. After reviewing the medical charts and chest X-rays of the patients, we calculated the tuberculosis scores. RESULTS: The majority of the subjects (80.4 percent) had a history of close household contact with an AFB-positive adult within the last two years. The tuberculin test was negative in 11 subjects (3.5 percent). According to the scoring system, 251 (79.4 percent) were very likely to have tuberculosis (score, > 40), 63 (19.9 percent) were moderately likely to have tuberculosis (score, 30-35), and 2 (0.7 percent) were unlikely to have tuberculosis (score, < 25). When a cut-off score of 30 was used, the sensitivity of this scoring system was 99.3 percent. CONCLUSIONS: In our sample, the sensitivity of this scoring system was high when the selected cut-off score was employed. If a cut-off score of 40 had been used, 20 percent of the subjects would not have been treated. Therefore, scores between 30 and 35 are critical for diagnostic confirmation. Judicious clinical evaluation should prevail in the decision of treating these patients. When the cut-off score of 30 is used, 30 percent of individuals with other pathologies will be treated for tuberculosis. This highlights the need for improved diagnostic methods for tuberculosis.

Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach.

OBJECTIVE: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. METHODS: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. RESULTS: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8%, 68.6%, and 94.5%, whereas the corresponding values for the diagnosis of pleural transudates were 76.1%, 90.1%, and 87.6%. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4%, 72.6%, and 99.2%, whereas the corresponding values for the diagnosis of transudates were 98.5%, 83.4%, and 90.0%. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). CONCLUSIONS: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística / Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach

OBJETIVO: Propor um novo critério de classificação para a diferenciação entre exsudatos e transudatos pleurais através da dosagem de proteínas totais no líquido pleural (PT-LP) e de desidrogenase lática no líquido pleural (DHL-LP) exclusivamente, assim como comparar o rendimento diagnóstico entre esse novo critério com o critério clássico. MÉTODOS: Estudo observacional, transversal de tipo individualizado, no qual foram selecionados 181 pacientes com derrame pleural tratados em dois hospitais universitários no estado do Rio de Janeiro (RJ) entre 2003 e 2006. Os parâmetros diagnósticos incluídos no critério clássico, assim como os do novo critério, foram determinados. RESULTADOS: Dos 181 pacientes, 152 e 29 foram diagnosticados, respectivamente, com exsudato pleural e transudato pleural. A sensibilidade, especificidade e acurácia do critério clássico para o diagnóstico de exsudato pleural foram, respectivamente, de 99,8 por cento, 68,6 por cento e 94,5 por cento, enquanto, para o diagnóstico de transudato pleural, essas foram de 76,1 por cento, 90,1 por cento e 87,6 por cento. Utilizando-se os pontos de corte de 3,4 g/dL para a dosagem de PT-LP e de 328,0 U/L para aquela de DHL-LP (novo critério), a sensibilidade, especificidade e acurácia foram de, respectivamente, 99,4 por cento, 72,6 por cento e 99,2 por cento, para o diagnóstico de exsudato, e de 98,5 por cento, 83,4 por cento e 90,0 por cento, para o diagnóstico de transudato. A acurácia do novo critério proposto para o diagnóstico de exsudato pleural foi significativamente maior que aquela do critério clássico (p = 0,0022). CONCLUSÕES: O rendimento diagnóstico dos dois critérios estudados foi semelhante. Portanto, esse novo critério de classificação pode ser utilizado na prática diária.

OBJECTIVE: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. METHODS: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. RESULTS: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8 percent, 68.6 percent, and 94.5 percent, whereas the corresponding values for the diagnosis of pleural transudates were 76.1 percent, 90.1 percent, and 87.6 percent. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4 percent, 72.6 percent, and 99.2 percent, whereas the corresponding values for the diagnosis of transudates were 98.5 percent, 83.4 percent, and 90.0 percent. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). CONCLUSIONS: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.

Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status.

OBJECTIVE: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. METHODS: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. RESULTS: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0% and 86.1% in the TB group, versus 75.0% and 58.3% in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0% and 53.9%, revealing combined parenchymal/lymph node alterations in 18.2% and 30.8%. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3% of the patients were malnourished (p < 0.005 vs. the LTB group). The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. CONCLUSIONS: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.

Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV / Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status

OBJETIVO: Verificar a eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde (MS), para o diagnóstico de TB pulmonar em crianças e adolescentes, infectadas ou não pelo HIV. MÉTODOS: Estudo analítico transversal realizado entre janeiro de 2002 e dezembro de 2006, no qual foram incluídos 239 indivíduos menores de 15 anos. Os pacientes foram divididos em quatro grupos: grupo TB latente (TBL; n = 81); grupo não TB (NTB; n = 41); grupo TB (n = 104); e grupo TB/HIV (n = 13). Foram estudadas as características clínicas, radiológicas e laboratoriais segundo o sistema de pontuação. RESULTADOS: Os relatos de febre, tosse, astenia e emagrecimento há mais de duas semanas foram significativamente maiores no grupo TB (p < 0,0001). No grupo TB, 95,0 por cento dos casos tinham história de contato com indivíduo com TB, sendo que em 86,1 por cento esse contato era intradomiciliar. No grupo TB/HIV, 75,0 por cento dos casos haviam entrado em contato com TB e, em 58,3 por cento, esse contato era intradomiciliar. Nos grupos TB e TB/HIV, respectivamente, 75,0 por cento e 53,9 por cento dos casos apresentaram alterações radiológicas parenquimatosas, enquanto 18,2 por cento e 30,8 por cento apresentaram alterações ganglionares e parenquimatosas. Os resultados da prova tuberculínica não apresentaram diferenças significativas entre os grupos. No grupo TB, 16,3 por cento dos pacientes estavam desnutridos (p < 0,005 vs. o grupo TBL). A pontuação média utilizando o sistema MS foi a seguinte: grupo TBL, 24,2; grupo NTB, 18,5; grupo TB, 45,3; e grupo TB/HIV, 41,5. CONCLUSÕES: Os pacientes dos grupos TB e TB/HIV apresentaram pontuação significativamente maior do que aqueles nos outros grupos. Portanto, esse sistema de pontuação foi válido para o diagnóstico de TB pulmonar nessa população, independentemente do status HIV.

OBJECTIVE: To determine the efficacy of the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) in children and adolescents, regardless of their HIV status. METHODS: This was a cross-sectional analytical study carried out between January of 2002 and December of 2006, involving 239 individuals less than 15 years of age. The patients were divided into four groups: latent TB (LTB group; n = 81); no-TB (NTB group; n = 41); TB group (n = 104); and TB/HIV group (n = 13). We studied the clinical, radiological and laboratory findings according to the scoring system. RESULTS: Reports of fever, cough, asthenia and weight loss for at least two weeks were significantly higher in the TB group (p < 0.0001). The proportion of cases with a history of any contact and household contact with a TB patient was, respectively, 95.0 percent and 86.1 percent in the TB group, versus 75.0 percent and 58.3 percent in the TB/HIV group. In the TB and TB/HIV groups, respectively, chest X-rays revealed parenchymal alterations in 75.0 percent and 53.9 percent, revealing combined parenchymal/lymph node alterations in 18.2 percent and 30.8 percent. There were no significant differences among the groups regarding the tuberculin skin test results. In the TB group, 16.3 percent of the patients were malnourished (p < 0.005 vs. the LTB group). The mean NMH system scores in the LTB, NTB, TB and TB/HIV groups were, respectively, 24.2, 18.5, 45.3 and 41.5. CONCLUSIONS: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.

Evaluation of a proposed diagnostic scoring system for pulmonary tuberculosis in Brazilian children.

In a case-control study to evaluate a systematic scoring system for diagnosing pulmonary tuberculosis (PTB) in children, cases had gastric lavage cultures positive for Mycobacterium tuberculosis and recovered after anti-tuberculosis treatment, while controls had negative cultures and recovered with non-anti-tuberculosis treatment. Radiological aspect (OR = 25.39), contact with a tuberculous adult (OR = 10.67) and tuberculin skin test > or = 10 mm (OR = 8.23) were associated with PTB diagnosis. The sensitivity of the score ranged from 58% to 89% and the specificity from 98% to 86%, with cut-offs of respectively > or = 40 or > or = 30. The scoring system may be a useful diagnostic method in areas with a high prevalence of TB.

Aspirado nasofaríngeo para el diagnóstico de la neumocistosis en pacientes pediátricos / Nasopharyngeal aspiration to the diagnosis of Pneumocystis carinii pneumonia in pediatric patients

Se analizaron 290 muestra correspondientes a 159 niños HIV(+), 5 neonatos HIV(-), 48 infantes HIV(-) con neumopatías severas, 10 niños HIV(-) que padecían diversos trastornos inmunológicos y 68 pacientes HIV(-) sin datos clínicos consignados, todos ellos internados en el Hospital de Niños Ricardo Gutiérrez con diagnóstico presuntivo de neumocistosis. En cada uno de los enfermos se obtuvieron diariamente, y durante 3 días consecutivos, muestras de secreciones nasofaringeas por aspiración con sonda nasogástrica. La investigación de P.carinii en los materiales se realizó mediante exámenes microscópicos, previas coloraciones de Giemsa y de azul de O-toluidina. 81 pacientes (51 por ciento) tuvieron resultados positivos en una de las 3 muestras, 51 (32 por ciento) en 2 de las 3 y los 27 restantes (17 por ciento) en todas las muestras recolectadas. La técnica empleada resultó de fácil realización, baja morbilidad y permitió un diagnóstico etiológico rápido de la neumocistosis en pacientes pediátricos (AU)

Aspirado nasofaríngeo para el diagnóstico de la neumocistosis en pacientes pediátricos / Nasopharyngeal aspiration to the diagnosis of Pneumocystis carinii pneumonia in pediatric patients

Se analizaron 290 muestra correspondientes a 159 niños HIV(+), 5 neonatos HIV(-), 48 infantes HIV(-) con neumopatías severas, 10 niños HIV(-) que padecían diversos trastornos inmunológicos y 68 pacientes HIV(-) sin datos clínicos consignados, todos ellos internados en el Hospital de Niños Ricardo Gutiérrez con diagnóstico presuntivo de neumocistosis. En cada uno de los enfermos se obtuvieron diariamente, y durante 3 días consecutivos, muestras de secreciones nasofaringeas por aspiración con sonda nasogástrica. La investigación de P.carinii en los materiales se realizó mediante exámenes microscópicos, previas coloraciones de Giemsa y de azul de O-toluidina. 81 pacientes (51 por ciento) tuvieron resultados positivos en una de las 3 muestras, 51 (32 por ciento) en 2 de las 3 y los 27 restantes (17 por ciento) en todas las muestras recolectadas. La técnica empleada resultó de fácil realización, baja morbilidad y permitió un diagnóstico etiológico rápido de la neumocistosis en pacientes pediátricos