INT J TUBERC LUNG DIS 18(5):531–533 Q 2014 The Union http://dx.doi.org/10.5588/ijtld.13.0793 SHORT COMMUNICATION Confirming the diagnosis of tuberculosis in children in Northern Portugal I. Ladeira,* A. M. Correia, † J. Dias, † R. Gaio, ‡ I. Carvalho,* § A. Carvalho,* § R. Duarte* †§¶# *Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, † Public Health Department, Administra¸ ca ˜ o Regional de Sa ´ ude do Norte, Oporto, ‡ Mathematics Center, Oporto University, § Centro de Diagn ´ ostico Pneumol ´ ogico, Vila Nova de Gaia, ¶ Department of Epidemiology, Preventive Medicine and Health of Medicine Faculty, Oporto University, Oporto, # Institute of Public Health, Oporto University, Oporto, Portugal SUMMARY Childhood tuberculosis (TB) is difficult to diagnose and there are no standardised case definitions. TB records of patients aged .5 years reported in Northern Portugal between 2000 and 2009 were reviewed. Of the 116 children diagnosed with TB, 72 (62.1%) were male; the mean age was 2.2 6 1.2 years. Of the 32 children (27.6%) with confirmed TB, only 46.7% had provided samples for culture, showing that little effort is made to obtain specimens for confirmation. We could not identify independent factors associated with the low rate of sample collection or anti-tuberculosis treatment without confirmation; chest radiography lesions were less frequent in children who began treatment without confirmation (adjusted OR 0.23, 95%CI 0.05–0.98). KEY WORDS: bacteriology; diagnosis; paediatric; tuberculosis IN 2011, according to World Health Organization (WHO) estimates, there were 8.7 million incident cases of tuberculosis (TB), 490 000 (6%) of which were children (aged ,15 years). 1 Only 19% of all childhood TB cases reported to the European Centre for Disease Prevention and Control (ECDC, Solna, Sweden) in 2009 were confirmed by culture. 2 Children aged ,5 years represent a risk group for active TB 3 and a challenge for TB diagnosis. In Portugal, 2388 TB cases were diagnosed in 2011, 4 representing a continuing decline since 2002, al- though Portugal remains an intermediate TB inci- dence country, the only one in Western Europe. In 2011, 17 children aged ,5 years were diagnosed with TB; almost all were residents of Lisbon and Oporto. 4 The aim of the present study was to determine the proportion of children aged ,5 years in Northern Portugal with confirmed diagnosis and identify the factors most often associated with anti-tuberculosis treatment without microbiological confirmation. MATERIAL AND METHODS A retrospective study was conducted of all children aged ,5 years treated for active TB among TB cases reported to the National Tuberculosis Surveillance System (SVIG-TB) in Northern Portugal between January 2000 and December 2009. In Portugal, all TB patients are diagnosed and treated free of charge. Children may be diagnosed either in hospitals (generally younger children with comorbidities or those requiring invasive diagnostic procedures) or in out-patient TB clinics. Portugal has a good country-wide laboratory network. It is manda- tory for clinicians to notify patients’ demographic characteristics, risk factors and TB information (diagnosis, treatment and outcome) to the SVIG-TB. Definitions Confirmed TB was defined as bacteriological confir- mation (positive culture); 1,2 non-confirmed TB was defined as absence of bacteriological TB confirma- tion. Non-invasive methods included sputum, urine and blood collection; invasive methods included bronchoscopy, gastric fluid collection, thoracocente- sis, lymph node biopsy, bone marrow biopsy and lumbar puncture. Continuous variables are presented as mean 6 standard deviation (SD) and categorical variables as absolute numbers or percentages. Logistic regression models were used to estimate crude and adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs). ORs were used to compare groups. Because we used retrospective surveillance data without the possibility of linking patient records to patient personal data, ethical approval was not deemed necessary. Correspondence to: Inˆ es Ladeira, Servi¸ co de Pneumologia do Centro Hospital de Vila Nova de Gaia/Espinho EPE, Rua Concei¸ ca ˜o Fernandes 4434-502 Vila Nova de Gaia, Portugal. Tel: ( þ 22) 786 5100. Fax: ( þ 22) 786 8359. e-mail: ines.ladeira@chvng.min-saude.pt Article submitted 28 October 2013. Final version accepted 31 December 2013.