Background: The diagnosis of childhood pulmonary tuberculosis presents a major challenge as symptoms traditionally associated with tuberculosis are extremely common in children from endemic areas. The natural history of tuberculosis in children shows that progressive disease is associated with symptoms which have a persistent, non remitting character. The aims of this study were to investigate whether improved symptom definition is possible in a clinical setting, and whether use of these well defined symptoms has improved value in the diagnosis of childhood pulmonary tuberculosis. Methods: A prospective, community based study was conducted in two suburbs of Cape Town, South Africa. All children (2 weeks duration, were referred to the investigator. Parents completed a symptom based questionnaire, whereafter reported symptoms were characterised in a standard fashion. Results: Of the 151 children enrolled, 21 (15.6% ) reported symptoms with a persistent, non remitting character. Tuberculosis was diagnosed in 16 (10.5% ) children, all of whom reported these symptom characteristics. A persistent, non remitting cough was reported in 15/16 (93.8% ) children with tuberculosis and in 2/135 (1.5% ) children without tuberculosis, indicating a specificity of 98.5% (135/ 137). Persistent fatigue of recent onset was also sensitive (13/16, 81.3% ) and specific (134/135, 99.3% ). Persistent fever and/or chest pain were exclusively reported in children with tuberculosis, but were present in only 4/16 (25.0% ) children with tuberculosis. Conclusion: The use of well defined symptoms is feasible, even in resource limited settings, and may offer significantly improved value in the diagnosis of childhood pulmonary tuberculosis.
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