Format

Send to

Choose Destination
Int J Tuberc Lung Dis. 2016 Jan;20(1):93-100. doi: 10.5588/ijtld.14.0848.

Understanding NIH clinical case definitions for pediatric intrathoracic TB by applying them to a clinical trial.

Author information

1
Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, New York, New York, USA.
2
Harvard School of Public Heath, Boston, Massachusetts, USA.
3
Rutgers New Jersey Medical School, The State University of New Jersey, Newark, New Jersey, USA.
4
Division of AIDS, Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.
5
Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, Faculty of Health Sciences, USA; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
6
Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
7
Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
8
University of Miami Miller School of Medicine, Miami, Florida, USA.

Abstract

SETTING:

Standardized clinical case definitions represent the best option for pediatric tuberculosis (TB) disease diagnosis and classification.

OBJECTIVE:

To apply published guidelines for intrathoracic TB classification for use in reporting diagnostic studies with passive case finding to presumed TB patients from International Maternal Pediatric Adolescent AIDS Clinical Trials P1041, a trial of isoniazid prophylaxis in healthy human immunodeficiency virus exposed, bacille Calmette-Guérin vaccinated infants which employed active surveillance to assess a novel application of these guidelines in this setting.

METHODS:

P1041 presumed TB patients were retrospectively cross-classified by protocol-defined and National Institutes of Health (NIH) classifications, and agreement was assessed.

RESULTS:

Of 219 TB suspects, 166 had signs/symptoms, with 158 considered TB (21 confirmed, 92 probable, 45 possible) and 8 not TB (6 TB unlikely, 2 alternative diagnoses). Weight loss and failure to thrive represented the majority of the observed signs/symptoms. Among those with signs/symptoms, agreement between definitions was poor. Furthermore, 53 TB presumptives were without signs/symptoms, including 33 classified by the P1041 protocol as TB.

CONCLUSION:

Poor agreement between P1041 and NIH classifications reflects cases identified through active vs. passive surveillance, the latter reflecting the intended use of NIH definitions. Given the interest in standardized definitions for broader application, future efforts could focus on expanding TB disease classification to presumed TB patients identified through active surveillance.

PMID:
26688534
PMCID:
PMC4928853
DOI:
10.5588/ijtld.14.0848
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Ingenta plc Icon for PubMed Central
Loading ...
Support Center