Spectrum of Childhood Tuberculosis: Ensuring and Making a Differential Diagnosis by Tuberculin Skin Test and Clinical Signs in Kisangani, DR Congo

Abstract

Background: Early diagnosis of childhood tuberculosis (CTB) could enable rapid diagnosis and management of TB epidemic within a community at high risk. This study was undertaken to determine the performance of Tuberculin Skin Test (TST) and influencing factors in the evaluation of CTB spectrum. Methods: This was a retrospective cross-sectional analysis of patients’ medical records carried out at a tertiary health center, from 05 March 2012 to 27 December 2013, in Kisangani city. The subjects were children and adolescent 6 months to 17 years old who have been tested for tuberculosis with TST alongside chest radiograph and clinical symptoms. Results: The spectrum of CTB approached 40% among 593 children tested, of which 31.5% were diagnosed with TST and 8.5% by other means. TST sensitivity was 78.3%. Presence of BCG vaccination may increase the positivity of TST. The prevalence of the infection was not significantly different between male and female, but was significantly lower in old children compared with infants 6-24 months old [OR=0.740;p=0.002]. All municipalities were affected, but Makiso and Tshopo housed the majority (OR=1.25). Contact with TB adult suspect significantly increased risk of primo-infection [OR=2.13;p=0.013]. Conclusion: The spectrum of TB is actually high in the city. TST remains the faster and more accessible test to diagnosing TB in this high endemic city but other clinical approaches should be used to not miss out TST false negative cases. Free testing should be envisaged to serve poorest families who cannot afford current costs.