Radiographic and other diagnostic tools used in tuberculous malnourished children in Kassala hospitals, Eastern Sudan

Abstract

Author(s): Alam Eldin Musa Mustafa Musa* and Mohammed Abdullah Alshehri

Objective: To evaluate the use of the WHO clinical criteria and the accelerated BCG test in diagnosing tuberculosis in malnourished children below five years of age admitted as diagnosed cases of tuberculosis to Kassala hospitals in the eastern part of Sudan.

Materials and Methods: A cross sectional hospital based study done in Kassala Teaching Hospital and Kuwaiti Paediatric Hospital during the period from January 2010 to December 2011. Data was collected through a questionnaire detailing full socio-demographic, nutritional and medical history. Examination, anthropometric measurements and investigations of the children included in the study.

Results: This study has included 84 children of almost equal gender distribution. The mean (SD) age was 28.8 months. Almost all were of low socio-economic class. 51(60.7%) were BCG vaccinated. Chest signs were seen in 66 of these patients (87.6%). The mantoux test was positive in 18 (21.7%) patients. The BCG test was accelerated in 51 (60.7%) of the 66 tested children. Chest radiographic changes were present in 88% of the study group. Pulmonary TB was diagnosed in 72.6% of this group. The WHO score was positive of ≥ 7 in 65 (78.6%) of the study group and was statistically significantly related to the chest radiography (p value>0.027) but association with the accelerated BCG test was not significant. (p>0.22). The IUATLD clinical score chart was positive of ≥ 5 in 75 patients (89.3%).

Conclusion and Recommendation: Conclusions are that pulmonary TB is prevalent in the study group. The use of accelerated BCG as a diagnostic test is feasible, sensitive and did not show any side effects. The use of the WHO and IUATLD clinical scores both were sensitive measures of diagnosis, but they use nonspecific criteria. The recommendation from this study is it has been advised to use of accelerated BCG testing in Mantoux negative patients in the diagnosis of tuberculosis in malnourished children.

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