[Values of a combination of multiple less invasive or non-invasive examinations in the diagnosis of pediatric sputum-negative pulmonary tuberculosis].

Objective: To study the values of a combination of multiple less invasive or non-invasive examinations including chest computed tomography (CT) scan, purified protein derivative (PPD) test, erythrocyte sedimentation rate (ESR) test, and C-reactive protein (CRP) test in the diagnosis of pediatric sputum-negative pulmonary tuberculosis (TB).

Methods: A retrospective analysis was performed on the clinical data of 269 children with confirmed pulmonary TB. Clinical symptoms and test results were analyzed and compared between the sputum-negative group (161 patients) and the sputum-positive group (108 patients).

Results: The sputum-negative group had atypical clinical symptoms, with fewer typical or relatively specific imaging features compared with the sputum-positive group. The positive rates of PPD, ESR, and CRP tests for the sputum-negative group were 39.1%, 44.1%, and 56.5%, respectively, versus 55.6%, 79.6%, and 59.3% for the sputum-positive group. There were significant differences in the positive rates of PPD and ESR tests between the two groups (P<0.05). More than 80% of the patients in each group were diagnosed with pulmonary TB according to three or four less invasive or non-invasive tests, without significant difference in the positive rate between the two groups (P>0.05). Forty-six patients in the sputum-negative group underwent bronchoscopy, and morphological changes with a diagnostic value and/or etiological and pathological evidence were observed in 40 (87.0%) of them.

Conclusions: The diagnosis rate of pediatric sputum-negative pulmonary TB can be increased by combining tests including chest CT scan, PPD test, ESR test, and CRP test. Bronchoscopy is a reliable method for the auxiliary diagnosis of pediatric sputum-negative pulmonary TB if the combining tests cannot provide compelling evidence.