Yonsei Med J.  2012 Nov;53(6):1176-1182. 10.3349/ymj.2012.53.6.1176.

Description of Pediatric Tuberculosis Evaluated in a Referral Center in Istanbul Turkey

• Gulec SG
• Telhan L
• Kockaya T
• Erdem E
• Bayraktar
• Palanduz A

• KMID: 1414261
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1176

Abstract

PURPOSE
Diagnosis of tuberculosis (TB) in children is more challenging than in adults. This study aimed to describe demographical, clinical and laboratory findings of children diagnosed with tuberculosis in Turkey, including the issues of contact tracing, culture positivity and forms of the disease.
MATERIALS AND METHODS
Clinical and laboratory data of 51 children with a mean age of 8.0+/-4.6 years who were diagnosed with TB were retrospectively reviewed. Main diagnostic tools included tuberculin skin test, chest X-ray, sputum/gastric aspirate culture with sensitivity testing, and direct microscopy for acid-fast bacilli on available samples. Clinical characteristics and outcomes of the patients were examined.
RESULTS
Thirty-six (70.6%) children were diagnosed with intra-thoracic and 15 (29.4%) with extra-thoracic tuberculosis. Twenty-eight of the patients had a positive Bacillus Calmette-Guerin vaccine scar (28/51, 54.9%) and 23/51 (45.1%) had a positive tuberculin skin test. An adult TB contact was identified in 27 (52.9%) of the cases. On direct microscopy, acid-fast bacilli were found in nine (17.6%) patients and positive culture for Mycobacterium tuberculosis was found in 19 (37.3%). Drug resistance to isoniazid was detected in four (7.8%). One patient with nephrotic syndrome and miliary tuberculosis died during follow-up. All other patients responded well to the treatment.
CONCLUSION
Focusing on active contact tracing among all household contacts of tuberculous cases may be helpful in early identification and controlling childhood disease, even in regions with low disease prevalence. Adopting a suspicious and proactive approach in this particular age group is warranted.

Keyword

Childhood tuberculosis; extra-thoracic tuberculosis; Mycobacterium tuberculosis; intra-thoracic tuberculosis; tuberculin skin test

MeSH Terms

Adolescent
BCG Vaccine/metabolism
Child
Child, Preschool
Female
Humans
Infant
Isoniazid/therapeutic use
Male
Mycobacterium tuberculosis/pathogenicity
Retrospective Studies
Risk Factors
Tuberculin/metabolism
Tuberculin Test
Tuberculosis/*diagnosis/drug therapy/metabolism
Tuberculosis, Pulmonary/diagnosis/drug therapy/metabolism
Turkey

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