A clinical approach to paediatric tuberculosis in Canada

Loculations and Associated Risk Factors of Childhood Pleural Tuberculosis

Background: Pleural loculation in childhood pleural tuberculosis (TB) remains a problem in practice, it is usually associated with failure drainage. Therefore, to improve the management of childhood pleural TB, a retrospective study was conducted to identify the risk factors associated with loculated effusion in childhood pleural TB. Methods: Between January 2006 and December 2019, consecutive children (≤15 years old) with tuberculous pleural effusion (definite and possible) were included for further analysis. The demographic, clinical, laboratory, and radiographic features were collected from the medical records. Univariate and multivariate logistic regressions were used to explore the factors associated with the presence of pleural loculation in children with pleural TB. Results: A total of 154 children with pleural TB (definite, 123 cases; possible, 31 cases) were included in our study and then were classified as loculated effusion (n = 27) and non-loculated effusion (n = 127) groups by chest X-ray or ultrasonography. Multivariate analysis revealed that male gender (age-adjusted OR = 3.903, 95% CI: 1.201, 12.683), empyema (age-adjusted OR = 4.499, 95% CI: 1.597, 12.673), peripheral monocytes ≤0.46 × 10⁹/L (age-adjusted OR = 4.122, 95% CI: 1.518, 11.193) were associated with the presence of loculated effusion in children with pleural TB. Conclusion: In conclusion, several characteristics, such as male gender, empyema, and peripheral monocyte count have been identified as risk factors for pleural loculation in children with pleural TB. Our findings may be helpful to improve the management of pleural loculation in childhood pleural TB.

Unexplained deterioration during antituberculous therapy in children and adolescents: clinical presentation and risk factors

BACKGROUND

Patients may unexpectedly deteriorate clinically and/or radiographically during the course of appropriate treatment for tuberculosis. These events have been extensively studied in human immunodeficiency virus-positive patients; however, there are few data about immunocompetent children and adolescents.

METHODS

We studied all human immunodeficiency virus-negative patients treated for tuberculosis at our center between January 2002 and July 2009. Demographics, sites of disease at diagnosis and deterioration, and actions at the time of deterioration were reviewed. Cases were compared with patients who remained well during therapy.

RESULTS

Unexplained deteriorations occurred in 15 of 110 patients (14%), all of whom were receiving directly observed therapy. The median time to deterioration was 80 days (range, 10-181 days). Enlarging intrathoracic lymphadenopathy often leading to severe airway compromise was common (7 of 15 patients). Four patients developed symptoms at sites remote from primary disease, including pericardial and pleural effusions and abdominal masses. Corticosteroid therapy was initiated in 9 patients. Deterioration was associated with multiple sites of disease at diagnosis (P = 0.02) and weight-for-age ≤25th percentile (P = 0.03).

CONCLUSIONS

Deteriorations during therapy occur frequently among immunocompetent children and may present months into treatment as clinically significant events. Those with lower weight-for-age percentiles and with multiple sites of disease at initial presentation are more likely to deteriorate. Many patients improve with corticosteroids, supporting an immunopathologic basis for many of these episodes. These deteriorations can be difficult to distinguish from drug resistance, treatment failure, or infection with other pathogens.

Drug-resistant tuberculosis: pediatric guidelines

Drug-resistant Mycobacterium tuberculosis (TB) infection represents a serious and growing problem. For patients infected or suspected of being infected with multidrug or extensively drug-resistant TB, several medications have to be given simultaneously for prolonged periods. Here, we review the literature on treatment and monitoring of adverse effects of pediatric drug-resistant TB therapy in a high resource, low TB burden setting.

Infection control and paediatric tuberculosis: A practical guide for the practicing paediatrician

Tuberculosis (TB) in children requires close attention to infection control to prevent transmission to other patients and health care workers. Although many children with TB are not infectious, appropriate airborne precautions must be maintained until conditions that increase the risk of transmission have been ruled out and accompanying adults, who may also be infectious, have been screened. Concurrent strategies to prevent TB transmission should be implemented, including administrative, engineering and personal protective measures. The most important measure is maintaining a high clinical index of suspicion for TB in patients with compatible symptoms and epidemiological risk factors. Comprehensive tuberculin skin test programmes and the use of N 95 masks can reduce the risk of transmission within health care settings. Current standards of practice should be followed to prevent transmission from patients with active TB disease.