Patient selection: HIV-positive child <= 13 years of age with cough > 2 weeks, fever > 2 weeks, weight loss (weight for age z-score < -2 SD), failure to antibiotics for a pulmonary infection
Parameters:
(1) history of contact with a TB case (smear positive)
(2) fever lasting > 2 weeks
(3) unremitting cough
(4) hemoptysis in previous 4 weeks
(5) weight loss in previous 4 weeks
(6) tachycardia
(7) miliary pattern on chest X-ray
(8) alveolar opacity on chest X-ray
(9) enlarged hilar lymph nodes on chest X-ray
(10) Xpert MTB/RIF test result (nucleic acid amplification)
(11) enlarged abdominal lymph nodes on ultrasonography
|
Parameter
|
Finding
|
Points
|
|
history of contact with TB patient
|
no
|
0
|
|
|
yes
|
118
|
|
fever lasting > 2 weeks
|
no
|
0
|
|
|
yes
|
66
|
|
unremitting cough
|
no
|
0
|
|
|
yes
|
39
|
|
hemoptysis
|
no
|
0
|
|
|
yes
|
79
|
|
weight loss
|
no
|
0
|
|
|
yes
|
24
|
|
tachycardia
|
no
|
0
|
|
|
yes
|
54
|
|
miliary pattern
|
no
|
0
|
|
|
yes
|
90
|
|
alveolar opacity
|
no
|
0
|
|
|
yes
|
74
|
|
hilar lymphadenopathy
|
no
|
0
|
|
|
yes
|
100
|
|
Xpert test
|
negative
|
0
|
|
|
positive
|
241
|
|
abdominal lymphadenopathy
|
no
|
0
|
|
|
yes
|
73
|
subscores for symptoms =
= (points for fever) + (points for cough) + (points for hemoptysis) + (points for weight loss) + (points for tachycardia)
subscore for testing =
= (points for miliary pattern) + (points for alveolar opacity) + (points for lymph nodes) + (points for Xpert test) + (points for abdominal lymph nodes)
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum subscore or total score: 0
• maximum subscore for symptoms: 262
• maximum subscore for testing: 578
• maximum score for all items: 958
• Antituberculous therapy was started if (1) history of contact with TB patient, (2) symptom subscore > 100, (3) testing subscore > 100.
Performance:
• The sensitivity was 90% with a specificity of 61%.
