To the Editor:

I read the recent report on the scoring system, recommended by the Brazilian National Ministry of Health (NMH), for the diagnosis of pulmonary tuberculosis (TB) with great interest.(1) Pedrozo et al. concluded that "The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups. Therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status."(1) I have some concerns regarding this report. First, the scoring system cannot exclude latent TB, which might be a major problem in actual practice. Second, it remains questionable whether the NMH system is a user-friendly tool. If it is not easy to use, it will not be employed. Third, to complete a diagnostic test assessment, the diagnostic properties (sensitivity, specificity, accuracy, precision, predictive value, etc.) and the cost-effectiveness should be evaluated and reported.

Viroj Wiwanitkit
Professor of Tropical Medicine, Visiting Professor, Hainan Medical College, China

References

1. Pedrozo C, Sant'Anna CC, March Mde F, Lucena SC. Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status. J Bras Pneumol. 2010;36(1):92-8.