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

Autor: João Carlos Coelho Filho, Marwal Araújo Caribé, Simone Castro Couto Caldas, Eduardo Martins Netto
Jazyk: English<br />Portuguese
Rok vydání: 2011
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Zdroj: Jornal Brasileiro de Pneumologia, Vol 37, Iss 3, Pp 288-293 (2011)
Druh dokumentu: article
ISSN: 1806-3713
1806-3756
DOI: 10.1590/S1806-37132011000300003
Popis: 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%) tinha história de contato domiciliar com adultos com BAAR positivo nos últimos dois anos. O teste tuberculínico foi negativo em 11 sujeitos (3,5%). Conforme o sistema de escore, 251 (79,4%) muito provavelmente tinham tuberculose (escores > 40), 63 (19,9%) possivelmente tinham tuberculose (escores entre 30 e 35) e 2 (0,7%) pouco provavelmente tinham tuberculose (escores < 25). A sensibilidade desse sistema de escore foi de 99,3%, 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% 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% dos indivíduos com outras patologias seriam tratados para tuberculose. Isto enfatiza a necessidade de melhores métodos diagnósticos para a tuberculoseOBJECTIVE: 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
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