Screening of Tuberculosis in Symptomatic Close Contact Children

Tuberculosis in children is one of the major causes of mortality in the third-world countries. Source of tuberculosis transmission to the children is infected adult patients with positive pulmonary smear who are in close contact with these children. This study conducted to reveal the rate of active tuberculosis among symptomatic close contact in children. We reviewed 124 children with symptoms and history of close contact with active tuberculosis between March 2000 and March 2002 in National Research Institute of Tuberculosis and Lung Disease (NRITLD). Diagnostic criteria used for detection of childhood tuberculosis consisted of having at least three out of five following criteria: clinical symptoms, history of close contact, radiological findings, positive PPD test, and positive bacteriological or pathologic findings. Of 124 cases, 65(52%) were female and 59(48%) were male. 68(55%) were Afghan refugees and 56(45%) were Iranian. All patients had positive clinical symptoms. 65(53%) of children had a PPD induration more than 10mm. Positive radiological findings (Chest-X-ray or Computed Tomography) were detected in 56(46%) cases. Mycobacterium tuberculosis was isolated from gastric washing fluid in 25(20%). Considering aforementioned criteria, 56(45%) patients were diagnosed as active tuberculosis while 68(55%) were received chemoprophylaxis. Among those with active disease, 23 had three positive criteria, 21 had four positive criteria, and 12 fulfilled whole criteria. Our results are important for the setting of priorities and rationalization of screening, chemoprophylaxis and early treatment measures, particularly among symptomatic close contacts in children. Multidisciplinary and multi-level approaches both by the government and private health care providers will have a positive impact on the childhood tuberculosis status in Iran. (Tanaffos 2003; 2(5), 51-56)