Pulmonary Tuberculosis in Children with Leukemia and Malignant Lymphoma

Lee, Gyung Hoon; Hah, Jeong Ok

Abstract

BACKGROUND: Tuberculosis(Tbc) has been known to be prevalent and associated with high mortality in adult patient with cancer due to cancer itself or immunosuppressive therapy but to be rare in children with cancer. Little about Tbc in children with cancer has been reported in this country. To investigate the incidence, treatment, timing of diagnosis, clinical symptoms and response to the treatment of Tbc in children with cancer, this study was undertaken.
METHODS
From 1983 until 1997, 252 children treated for cancer at the Department of Pediatrics of Yeungnam University Hospital were studied for developing pulmonary Tbc while receiving anticancer therapy by reviewing the medical records. The incidence, onset, clinical symptoms and the response to the therapy of pulmonary Tbc in these children with cancer were studied.
RESULTS
Among 252 children with cancer, 8(3.2%) children developed pulmonary Tbc which included 5 of 128(3.9%) children with ALL, 3 of 25(12%) children with malignant lymphoma. These 3 malignant lymphoma included 2 of total 3(66.7%) Hodgkin's lymphoma and 1 of 1(100%) lymphoepithelioma of the study population. Incidence of pulmonary Tbc in children with cancer per 100 person year for the first year was 2.9, for the second year was 1.4. Among 8 children with pulmonary Tbc, five were male and 3 were female with male to female ratio of 1.67:1. Mean age of them was 13.2(5~18) years old. The onset of pulmonary Tbc was average 7.1(2~14) months after starting anticancer therapy. No one had pulmonary Tbc on diagnosis of cancer. Coughing, sputum, cold sweating, mild fever, loss of appetite, weight loss were the clinical symptoms on diagnosis of pulmonary Tbc. Chest X-ray showed findings compatible with the active pulmonary Tbc in all cases but sputum examination for acid fast bacilli by direct smear, culture or polymerase chain reaction were all negative. They were treated with isoniazid and rifampin for average 22.7+/-7.2(16.5~23.6) months with combination of streptomycin or kanamycin for first one month. All patients started to show signs of improvement clinically within several days and radiologically within few weeks after starting anti-Tbc therapy and eventually recovered from pulmonary Tbc completely.
CONCLUSIONS
It seems to be important to recognize that incidence of pulmonary Tbc is higher in children with cancer, especially in those with leukemia and malignant lymphoma, especially Hodgkin's whose cellular immunity is suppressed, than immunocompetent children. Thus when these patients shows symptoms of coughing, sputum, cold sweating, mild fever, fatigue, loss of appetite or weight loss, chest X-ray and studies for Tbc are indicated for prompt diagnosis and treatment for pulmonary Tbc in children with cancer.