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correspondence

Indian Pediatr 2013;50: 803

Pediatric Tuberculosis

Baljinder Kaur

Assistant professor, Department of Pediatrics, GMC and RH Patiala, Punjab, India.
Email: banga.baljinder@yahoo.com
 


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 [1]. 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 sensitivity testing.

Reference

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.


Reply

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
Email: 4vsingh@gmail.com

 

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