Ben J. Mris, MRCP, FCP, MMed, PhD, Robert P. Gie, FCP, Anneke C. Hesseling, MBChB, MSc, H. Simon Schf, MMed, MD, Crl Lombrd, PhD b, Donld A. Enrson, MD, PhD c nd Nuld Beyers, FCP, MSc, PhD Desmond Tutu Tuberculosis Centre nd Deprtment of Peditrics nd Child Helth, Tygerberg Children's Hospitl, Stellenbosch University, Cpe Town, South Afric; b Medicl Reserch Council of South Afric, Cpe Town, South Afric; c Interntionl Union Aginst Tuberculosis nd Lung Disese, Pris, Frnce (symptom-bsed); (dignosis); (tuberculosis); (children) TST = tuberculin skin test CXR = chest rdiogrph PPV = positive predictive vlue OR = odds rtio CI = confidence intervl (Cpe Town) Address correspondence to 2 wk 13 ( Ben J. Mris, MRCP, FCP, ) MMed, PhD, Deprtment of Peditrics nd Child Helth, Desmond Tutu Tuberculosis Centre, Fculty of Helth Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Afric. E-mil: bjmris E-mil: 4 bjmris@sun.c.z PEDIATRICS 2007 2 2 2 293
20% ( ) 3 HIV 2 wk 3 mo ( ) 3 3 mo 10% ( 68.3% 80.1% 82.1%) (1) (2) (3) HIV 1 024 596 (58.2%) 428 (41.8%) T 197 HIV 96 75 26 2 wk 12 ( 3 mo ) 3 11 (91.7%) HIV 11 3 HIV ( 62.6% 89.8% 83.6%) ( 3 82.3% 90.2% 82.3%) ( ( ) 3 51.8% 92.5% HIV 90.1%) HIV ( ) HIV HIV 20 HIV 3 (15%) 25% HIV HIV 294 MARAIS et l
[11] HIV [12, 13] HIV [14] [15] ( 3 ) [1, 2] [15] [3] 3 ( ) [4] [15] [5, 6] [5, 6] [16] 10% 15% 30% 40% [4, 7] (1) (2) (TST) (3) (CXR) ( ) [8, 9] CXR 2003 2 2005 1 [10] CXR 2004 845 / 100 000 13 407 / 100 000 [17] HIV 8.8% [17] 5 Tygerberg PEDIATRICS 2007 2 2 2 295
13 3 ( ) 2 mo 2 ( ) 4 mo 13 ( ) TST 2 2 wk 1 2 4 wk 4 wk TST ( ) CXR (1) (2) (3) 5 ( ) 1 (Ntionl Tuberculosis Progrmme) Tygerberg 3mo ( ) 3 mo ( ) TST TST 2 (PPD RT 23 Sttens Serum Institut Copenhgen Denmrk) 48 72 h (Rod-to-Helth (mm) TST HIV growth chrt) 3 mo 10 mm HIV TST CXR 1 5mm ( ) HIV CXR 296 MARAIS et l
2wk ( 13 ) n =1024 n =596 n =428 n =596 n =233 n =197 4wk n =205 n =96 n =75 4wk n =188 n =17 n =26 n =6 n =32 n =11 1 MGIT (Becton Dickinson Sprks MD) [19] [18] HIV HIV (Determine HIV 1 / 2 rpid test Abbott Tokyo Jpn) ( ) Tygerberg HIV ( 18 ) 3 mo 1 10% BACTEC PEDIATRICS 2007 2 2 2 297
1 2 wk Stellenbosch (n = 1 024) (%) (n = 596) 3 y 287 (48.2) 3 y 309 (51.8) 297 (49.8) 299 (50.2) HIV 0 0 (n = 428) 3 y 185 (43.2) 3 y 243 (56.8) 225 (52.6) 203 (47.4) HIV 297 (69.4) 37 / 297 (12.4) 26 / 74 (35.1) 11 / 223 (4.9) TST 10 mm ( HIV) 226 / 384 (58.8) 5 mm ( HIV) 6 / 37 (16.2) 197 (46.0) HIV 17 / 197 (8.6) 3 y ( HIV) 94 / 197 (47.7) 3 y ( HIV) 86 / 197 (43.6) Access (Microsoft Redmond WA) SSPS 13.0 (SSPS Inc Chicgo IL) (PPV) (1) 3 HIV (2) HIV 3 HIV 3 PPV 1 024 596 (58.2%) 428 (41.8%) 197 ( 1) HIV 1 ( ) (1) (2) (3) HIV ( HIV ) 26 / 74 (35.1%) 11 / 223 (4.9%) OR 7.12 95% CI 3.18 16.22 HIV 2 298 MARAIS et l
425 ( ) 214 197 (92.1%) 17 5 3 (29.4%) TST 3 (17.6%) ( ) HIV HIV TST 2 wk (1 HIV 2 HIV 3 HIV TST ) 9 (53.0%) ( ) HIV 156 / 3 2 wk 6 (2 179 (87.2%) 3 / 17 (17.6%) OR 31.6 95% HIV 6 HIV 3 1 HIV 1 3 ( ) CI 7.6 151.5 HIV 3 ) HIV TST 9 / 17 (52.9%) 3 / 17 (17.6%) OR 5.2 95% CI 0.89 34.7 4 ( ) 3 14 2 2 2 PPV 2 HIV 2 2 3 2 ( ) (%) CXR ( ) 84 (19.8) 0 / 84 4 / 84 (4.8) 45 (10.6) 0 / 45 0 / 45 CXR 69 (16.2) 3 / 69 (4.3) 27 / 69 (39.1) 76 (1.2) 76 / 76 (100) 71 / 76 (93.4) ( ) 107 (25.2) 101 / 107 (100) 104 / 107 (97.2) ( ) 14 (3.0) 14 / 14 (100) 5 / 14 (35.7) 14 (3.3) 14 / 14 (100) 14 / 14 (100) ( ) 17 (4.0) 0 / 17 4 / 17 (23.5) 425 (100) 214 / 425 (50.4) 197 / 214 (92.1) 425 229 197 (86%) ( 1) PEDIATRICS 2007 2 2 2 299
3 ( ) PPV HIV ( 3 ) HIV ( 3 ) HIV PPV PPV PPV 3 wk 90.7 65.7 33.8 80.9 58.1 33.5 100 45.0 60.7 4 wk 73.3 90.1 58.9 59.6 89.9 60.2 88.2 65.0 68.2 9.3 96.9 36.4 3.2 99.7 75.0 0 95.0 0 5.8 98.1 38.4 1.1 100 100 0 95.0 0 4.7 99.1 50.0 8.5 94.9 30.8 35.3 60.6 42.8 37.2 92.4 48.5 43.6 89.9 52.6 52.9 30.0 39.1 57.0 93.9 64.5 40.4 95.2 70.3 41.2 60.0 46.7 94.2 87.0 58.3 68.1 95.5 78.0 94.1 30.0 53.3 70.9 84.8 47.3 60.6 91.9 65.5 88.2 30.0 51.7 82.4 84.4 75.0 75.3 79.1 82.1 82.3 35.0 51.9 TST 89.3 62.9 59.1 81.9 70.1 77.7 17.6 85.0 50.0 48.8 72.3 52.5 69.1 53.6 67.0 52.9 60.0 52.9 1 ( ) 3 mo [28] 3 mo ( ) ST 10 mm ( HIV 5 mm) 12 mo TST ( 67.3% 93.8% PPV 93.2%) ( 51.8% 92.5% 4 wk 3 ( 98.6% PPV 88.6%) HIV PPV 90.1%) (3 ) ( 56.2% 75.0% PPV 77.2%) ( 100%) 2wk HIV 3 HIV ( 3 98.9% PPV 85.1% 3 82.6% PPV 88.6%) 3 300 MARAIS et l
50% ( 0.9 2 ) 0.7 3 (1) 0.5 2 wk (2) 3 mo 0 0.5 1.0 ( ) (3) 1-3 HIV 2 HIV 81% 20% 3 ( x 0) ( y 1) 3 ( 4) HIV ( ) ( ) ( 68.3% 3 HIV 80.1% PPV 82.1%) ( ) ( ) 4 TST 3 [20] ( ) PPV PPV 3 HIV 82.3 90.2 82.3 3 HIV 51.8 92.5 90.1 HIV ( ) 56.2 61.8 61.9 HIV 20 HIV 3 (15%) 25% HIV TST 20% HIV TST 3 3 (1) 2 wk (2) (3) ) 3 mo ( ) ( HIV HIV 3 HIV 3 PEDIATRICS 2007 2 2 2 301
[21] HIV [3, 27] HIV T ELISPOT HIV HIV [22] [23] TST HIV [24] ( 5 ) [25] 17 2 12 mo 3 HIV ( ) HIV ( ) [15, 26] (pretest) 12 ( ) ( ) ( ) 11 (91.7%) 3 HIV ( ) HIV HIV ( ( ) ) HIV HIV HIV ( ) 302 MARAIS et l
1 Wlls T, et l. J Infect 2004;48:13 22 2 Nelson LJ, et l. Int J Tuberc Lung Dis 2004;8:636 647 3 Chintu C, et l. Lncet 2002;360:985 990 4 Strke JR. Tuberculosis 2003;83:208 212 5 Osborne CM. Arch Dis Child 1995;72:369 374 6 Emrnond P, et l. Int J Tuberc Lung Dis 2001;5:594 603 7 Zr HJ, et l. Lncet 2005;365:130 134 8 Weismuller MM, et l. Int J Tuberc Lung Dis 2002;5:432 438 9 Thert AC, et l. Int J Tuberc Lung Dis 2005;9:1210 1214 10 Du Toit G, et l. Int J Tuberc Lung Dis 2002;6:814 817 11 Hesseling AC, et l. Int J Tuberc Lung Dis 2002;6:1038 1045 12 Slzr GE, et l. Peditrics 2001;108:448 453 13 Schf HS, et l. Peditr Infect Dis J 1995;14:189 194 14 Mris BJ, et l. Arch Dis Child 2005;90:1166 1177 15 Mris BJ, et l. Int J Tuberc Lung Dis 2004;8:392 402 16 Mris BJ, et l. Arch Dis Child 2005;90:1162 1165 17 Mris BJ, et l. Int J Tuberc Lung Dis 2006;10:259 263 18 Mris BJ, et l. Peditr Rdiol 2004;33:886 894 19 de Wit D, et l. Clin Microbiol 1990;28:2437 2441 20 Obihr CC, et l. Clin Expllergy 2006;36:70 76 21 Mdhi SA, et l. Peditr Infect Dis J 18:800 805 22 Liebeschuetz, et l. Lncet 2004;364:2196 2203 23 Dhed K, et l. AIDS 2005;18:2038 2041 24 Mris BJ, et l. Am J Resp Crit Cre Med 2006;173:1078 1090 25 World Helth Orgniztion. Tuberculosis in children. In: Tretment of Tuberculosis; Guidelines for Ntionl Tuberculosis Progrmmes. 3rd ed. Genev, Switzerlnd: World Helth Orgniztion; 2003 26 Mris BJ, et l. Ann Trop Ped 2005;25:79 86 27 Chintu C, et l. Peditr Infect Dis J 993:499 504 28 Ntionl Center for Helth Sttistics in collbortion with the Ntionl Center for Chronic Disese Prevention nd Helth Promotion. Growth chrts (2000). Avilble t: www.cdc.gov / growthchrts. Accessed September 5, 2006 PEDIATRICS 2006;118(5):e1350 e1359 PEDIATRICS 2007 2 2 2 303