Tuberculosis Diagnosis in HIV-Infected Children: Comparison of the 2012 and 2015 Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease

Olivier Marcy (1, 2) , Sophie Goyet (3) , Laurence Borand (3) , Philippe Msellati (4) , Vibol Ung (5) , Mathurin Tejiokem (6) , Giang Do Chau (7) , Francis Ateba-Ndongo (8, 9) , Abdoul Salam Ouedraogo (10) , Bunnet Dim (3) , Paul Perez (1) , Julien Asselineau (1) , Guislaine Carcelain (11) , Stephane Blanche (12) , Christophe Delacourt (12) , Sylvain Godreuil (13, 14)

1 BPH - Bordeaux population health
2 GHiGS - Global Health in the Global South
3 Institut Pasteur du Cambodge
4 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
5 UHS - University of Health Sciences [Phnom-Penh, Cambodia]
6 Centre Pasteur du Cameroun
7 Pham Ngoc Thach Hospital
8 Centre Mère et Enfant de la Fondation Chantal Biya
9 FCB - Fondation Chantal Biya
10 CHUSS - Centre Hospitalier Universitaire Souro Sanou [Bobo-Dioulasso]
11 AP-HP Hôpital universitaire Robert-Debré [Paris]
12 Hôpital Necker - Enfants Malades [AP-HP]
13 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
14 MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle

BACKGROUND: There is no gold standard for tuberculosis diagnosis in children. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children were proposed by international experts in 2012 and updated in 2015. We aimed to compare the 2012 and 2015 Clinical Case Definitions in HIV-infected children with suspected tuberculosis. METHODS: We enrolled HIV-infected children with suspected tuberculosis in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS [Agence Nationale de Recherches sur le SIDA et les hepatites virales] 12229 PAANTHER [Pediatric Asian African Network for Tuberculosis and HIV Research] 01 Study). We classified children using the 2012 and 2015 Case Definitions considering as tuberculosis cases those with confirmed tuberculosis and those with probable and unconfirmed tuberculosis in the 2012 and the 2015 classifications, respectively. We assessed agreement between both classifications. RESULTS: Of 438 children enrolled, 197 (45.0%) children were classified as tuberculosis (45 confirmed, 152 probable) using the 2012 Case Definition and 251 (57.3%) were classified as tuberculosis (55 confirmed, 196 unconfirmed) using the 2015 classification. Inter-classification agreement for tuberculosis diagnosis was 364/438, 83.1%, with a kappa statistic of 0.667 (95% confidence interval 0.598-0.736). Of 152 children with probable tuberculosis (2012), 142 (93.4%) were considered as tuberculosis by the 2015 version and 10 (6.6%) as unlikely tuberculosis including 9 with spontaneous clinical improvement. Of 132 possible tuberculosis (2012), 58 (43.9%) were reclassified as tuberculosis (2015). CONCLUSIONS: Agreement between the 2 versions of the Case Definition was substantial but more children were considered as tuberculosis using the 2015 version. Spontaneous symptom resolution reinforces both confidence in the "unlikely" category as being children without tuberculosis and the importance of the clinician's treatment decision in the study.

Mots clés: HIV infections; Tuberculosis of intrathoracic lymph nodes; Tuberculosis

Domaines: Santé publique et épidémiologie

Olivier Marcy, Sophie Goyet, Laurence Borand, Philippe Msellati, Vibol Ung, et al.. Tuberculosis Diagnosis in HIV-Infected Children: Comparison of the 2012 and 2015 Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Journal of the Pediatric Infectious Diseases Society, 2021, ⟨10.1093/jpids/piab113⟩. ⟨hal-03540832⟩