Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

• Published in: Jornal brasileiro de pneumologia 2013-01, Vol.39 (1), p.84-91
• Main Authors: Santos, Sandra Christo dos, Marques, Ana Maria Campos, Oliveira, Roselene Lopes de, Cunha, Rivaldo Venâncio da
• Format: Article
• Language: eng ; por
• Subjects: Adolescent; Brazil; Child; Child, Preschool; Contact Tracing; Diagnostic Techniques, Respiratory System - standards; Female; Government Agencies; Humans; Indians, South American; Male; Nutritional Status - physiology; Original; Retrospective Studies; Tuberculin Test; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - ethnology; Tuberculosis, Pulmonary - transmission
• ISSN: 1806-3713; 1806-3756
• DOI: 10.1590/S1806-37132013000100012

To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.