Simple Clinical Score Predicts Tuberculosis in HIV-Positive Children

GRAZ, Austria (Reuters Health) May 20 - A scoring scale based on readily available clinical information can help diagnose tuberculosis in HIV-positive children in rural areas, researchers from Rwanda reported recently at the annual meeting of the European Society for Paediatric Infectious Diseases held in Graz, Austria.

“As no specific gold standard exists for tuberculosis diagnosis, clinical score is helpful in contexts where expertise and exams are not available,” noted Dr. K. Kayumba from the Treatment and Research AIDS Center, Kigali, Rwanda.

In a retrospective study, Dr. Kayumba and his team applied their “Rwandan Pediatric Society” clinical score to 198 HIV-infected children who had been investigated and treated for tuberculosis, based on existing standards.

Per the RPS scoring system, fever for more than15 days despite treatment with antibiotics and antimalarials and cough persisting for more than 15 days after antibiotics were the obligatory symptoms for a diagnosis of TB. Other factors (when available) contributing to the score included malnutrition, HIV positivity, history of contact with tuberculosis, positive sputum smear, tuberculin reaction of over 10 mm, or a suggestive X-ray.

The RPS score resulted in a sensitivity and specificity of 89.1% and 72.7%, respectively, and positive and negative predictive values of 76.5% and 86.7%, respectively, Dr. Kayumba and colleagues found. In comparison, the sensitivity and specificity of the well established Crofton scores were 97% and 50.5% when applied to their patient data; corresponding values for the Brazilian score were 82.2% and 73.2%, the researchers noted.

“The Rwandan Pediatric Society Score can be used in resource-poor settings and in children without HIV also,” Dr. Kayumba said. “The score should be used everywhere, as children are rarely treated for tuberculosis in a rural context, ” he concluded.

Source:

1. Simple Clinical Score Predicts Tuberculosis in HIV-Positive Children