Indian Pediatr 2013;50: 803
Assistant professor, Department of Pediatrics, GMC and
RH Patiala, Punjab, India.
I read the recent updated guidelines for pediatric tuberculosis in India
with interest, and found them to be informative. However, there may be
practical difficulty in evaluating exact weight loss which has been
defined as weight loss more than 5% of highest weight recorded in 3
months . Weight loss in terms of percentage can only be defined if
previous weight of the child is known. Common presentation of children
belonging to rural area is anorexia, fever and complain by parents of
weight loss as measured from dress size.
What are suggestions of the authors regarding
interval between subsequent repetition of tuberculin sensitivity test as
TST is being used as a tool to diagnose pediatric tuberculosis in
conjunction with sputum and gastric lavage microscopy along with chest
X-ray; every time child presents with unexplained fever, anorexia and
weight loss. Should it not be recommended to keep a record of tuberculin
1. Kumar A, Gupta D, Sharath BN, Singh V, Sethi GR,
Prasad J. Updated guidelines for pediatric tuberculosis in India 2012.
Indian Pediatr. 2013;50:302.
In response to Kaur, we wish to state
that (a) while it is true that the weight records may
not be available in many situations but objectively defining
these symptoms to cleanly identify disease suspect leads to
a better yield as it will improve the performance of the
diagnostic algorithm. In the event where the exact weight
loss cannot be quantified, one may still investigate for TB
if the clinical suspicion is high; (b) prior TST
testing, even when repeated, is not considered likely to
give rise to false positive reactions.
Varinder Singh and BN Sharath