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Vadlapudi SS, Srivastava A, Saini N, Sen Sarma M, Poddar U, Yachha SK. Aetiology and diagnostic utility of serum ascites albumin gradient in children with ascites. Dig Liver Dis 2024:S1590-8658(24)00264-0. [PMID: 38429139 DOI: 10.1016/j.dld.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/18/2023] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Ascites in children is multifactorial and serum ascites albumin gradient (SAAG) ≥1.1 helps differentiate portal hypertension (PHTN) related from non-PHTN ascites. AIMS We evaluated the aetiology and diagnostic accuracy of SAAG in children with ascites. METHODS Children with ascites were retrospectively evaluated. Etiological diagnosis was based on clinical presentation and investigations. All cases with ascitic fluid analysis and a definite diagnosis were included for calculating the utility of SAAG. RESULTS We enrolled 878 children (568[64.7%] boys). Majority were PHTN related (638[72.7%]) and secondary to acute viral hepatitis (98,15.4%), acute liver failure (185,29%), chronic liver disease (276,43.3%) and Budd-Chiari syndrome (79,12.4%). Other causes included tubercular (46,5.2%), pancreatic (32,3.6%), chylous (20,2.3%), biliary (12,1.4%), pseudoascites (16,1.8%), infections (46,5.2%), nephrotic (26,2.9%), malignancy (23,2.6%), cardiac (9,1.0%) and others (10,1%). SAAG (n = 305) correctly differentiated PHTN and non-PHTN ascites in 272 (89.2%) cases, with a high sensitivity (97%), specificity (93%) and diagnostic accuracy (95.8%). Reasons for inaccurate SAAG included mixed ascites (n = 9), different day serum and ascitic fluid albumin estimation (n = 5), serum albumin ≤1.1 g/dL (n = 2), chylous ascites (n = 3), hypergammaglobulinemia (n = 1), albumin infusions (n = 1) and unexplained (n = 12). CONCLUSIONS Nearly 27% children had non-PHTN related ascites. SAAG differentiates PHTN from non-PHTN ascites with a diagnostic accuracy of 95%.
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Affiliation(s)
- Srinivas Srinidhi Vadlapudi
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Nidhi Saini
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Moinak Sen Sarma
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ujjal Poddar
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Surender Kumar Yachha
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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2
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Mahomed N, Kilborn T, Smit EJ, Chu WCW, Young CYM, Koranteng N, Kasznia-Brown J, Winant AJ, Lee EY, Sodhi KS. Tuberculosis revisted: classic imaging findings in childhood. Pediatr Radiol 2023; 53:1799-1828. [PMID: 37217783 PMCID: PMC10421797 DOI: 10.1007/s00247-023-05648-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023]
Abstract
Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.
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Affiliation(s)
- Nasreen Mahomed
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa.
| | - Tracy Kilborn
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Elsabe Jacoba Smit
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Winnie Chiu Wing Chu
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Catherine Yee Man Young
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nonceba Koranteng
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Kushaljit Singh Sodhi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
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3
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Donald JS, Ratcliffe A, Lee A, Cooley L, Tomlinson N, Lambeth MJ. Crohn's disease versus gastrointestinal tuberculosis: A diagnostic dilemma. J Paediatr Child Health 2022; 58:2093-2095. [PMID: 35735067 DOI: 10.1111/jpc.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/27/2022] [Accepted: 05/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Julia S Donald
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Alison Ratcliffe
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Amy Lee
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Louise Cooley
- Department of Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Naomi Tomlinson
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Department of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Melissa J Lambeth
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Department of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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4
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Lukosiute-Urboniene A, Dekeryte I, Donielaite-Anise K, Kilda A, Barauskas V. Challenging diagnosis of abdominal tuberculosis in children: cases report. Int J Infect Dis 2021; 116:130-132. [PMID: 34954096 DOI: 10.1016/j.ijid.2021.12.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022] Open
Abstract
Tuberculosis (TB) remains a significant cause of morbidity and mortality in the modern world. Abdominal tuberculosis is a rare form of extrapulmonary TB, especially in children without comorbidities, although exact numbers are unavailable because of lack of the data and its rarity. Diagnosis of abdominal TB remains a challenge, because of its unspecific clinical features and unclear recommendations for the best diagnostic tools. We represent 4 cases of children abdominal tuberculosis diagnosed at The Hospital of Lithuanian University of Health Sciences (LUHS) Kaunas clinics from 2008 to 2018 at the Department of Paediatric surgery. All these cases are exceptional. The final diagnosis of abdominal TB was confirmed only after diagnostic laparoscopy and biopsy. Moreover, we suggest that Quantiferon test and ascitic fluid analysis with SAAG and ADA tests should be performed before more invasive interventions. Laparoscopy with biopsy should be done only in still unclear cases.
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Affiliation(s)
- Ausra Lukosiute-Urboniene
- Lithuanian University of Health Sciences, Department of Paediatric surgery, Eiveniu street 2, Kaunas, Lithuania.
| | - Inga Dekeryte
- Lithuanian University of Health Sciences, Department of Paediatric surgery, Eiveniu street 2, Kaunas, Lithuania.
| | - Kamile Donielaite-Anise
- Lithuanian University of Health Sciences, Department of Paediatric surgery, Eiveniu street 2, Kaunas, Lithuania.
| | - Arturas Kilda
- Lithuanian University of Health Sciences, Department of Paediatric surgery, Eiveniu street 2, Kaunas, Lithuania.
| | - Vidmantas Barauskas
- Lithuanian University of Health Sciences, Department of Paediatric surgery, Eiveniu street 2, Kaunas, Lithuania.
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5
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Matettore A, Rajaprakash M, Bennett M, Skarsgard ED, Goldman RD. Abdominal Tuberculosis in an Infant Presenting With a Small Bowel Obstruction. Pediatr Emerg Care 2021; 37:e406-e407. [PMID: 31283724 DOI: 10.1097/pec.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Abdominal tuberculosis (TB) is rare in children and usually spread in the peritoneum or gastrointestinal tract. Symptoms tend to be vague and nonspecific, with no extra-abdominal involvement, presenting a challenge for clinicians and delayed diagnosis. Postnatally acquired abdominal TB is most commonly transmitted through inhalation or ingestion of respiratory droplets with Mycobacterium tuberculosis from the mother.Abdominal TB in infants is rare. We present a case of a 2-month-old infant presenting with an acute bowel obstruction secondary to abdominal TB acquired through contact with maternal TB mastitis. This unique case emphasizes the importance of considering abdominal TB in the differential for at-risk infants presenting with small bowel obstruction.
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6
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Rossi A, Melone V, Turco R, Camera L, Bruzzese E, Miele E, Staiano A, Guarino A, Lo Vecchio A. Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report. Ital J Pediatr 2020; 46:49. [PMID: 32307013 PMCID: PMC7169001 DOI: 10.1186/s13052-020-0816-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ascites can develop as a consequence of a number of diseases in childhood. Despite chronic liver disease is the most common cause, several conditions can lead to ascites also in the absence of liver dysfunction. As non-cirrhotic ascites shows a high degree of overlapping sign and symptoms it is still a challenge for physicians. CASE PRESENTATION A 8-year-old Caucasian girl was referred for fever, vomit and diarrhea occurred over the past few weeks. Physical examination showed timpanitic distension of the abdomen with marked tenderness and increased abdominal wall rigidity. Abdominal imaging showed diffuse ascites and thickened omentum and bowel wall. Blood tests showed increased C- reactive protein levels and decreased lymphocyte count. Specific treatment for inflammatory bowel disease was started. Persisting of ascites required additional investigations. Positive tuberculin skin test and Interferon Gamma release assay (IGRA) as well as increased Ca125 serum concentrations were found. Computed tomography scan showed mediastinal and mesenteric adenopathies and diffuse smooth thickening of the omentum with significant enhancement (omental cake-like). Ascitic fluid analysis revealed high leucocytes and protein levels. Presumptive diagnosis of peritoneal tuberculosis (PTB) was made. Antituberculous treatment resulted in the resolution of ascites and normalization of lymphocyte count and Ca125 serum concentrations. CONCLUSIONS PTB is still possible in low-prevalence countries. As it is a great mimicker of other abdominal pathology whose treatment might worsen tuberculosis progression, clinical suspicion and adequate screening are required to avoid unnecessary interventions and delayed treatment. Ca125 is a non-specific marker of peritoneal inflammation but it might be helpful in monitoring the treatment response.
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Affiliation(s)
- Alessandro Rossi
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Velia Melone
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Rossella Turco
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, Section of Diagnostic Imaging, University of Naples "Federico II", Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Erasmo Miele
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
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7
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Lal SB, Bolia R, Menon JV, Venkatesh V, Bhatia A, Vaiphei K, Yadav R, Sethi S. Abdominal tuberculosis in children: A real-world experience of 218 cases from an endemic region. JGH OPEN 2019; 4:215-220. [PMID: 32280767 PMCID: PMC7144780 DOI: 10.1002/jgh3.12245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Background and Aim Abdominal tuberculosis (ATB) in children poses a diagnostic challenge because of its nonspecific clinical features, which often delay the diagnosis. Our aim was to present our real-world experience and provide an insight into the presentation, pattern of distribution, and diagnosis of the disease. Methods A retrospective review was conducted of case records of all children ≤12 years of age diagnosed with ATB from January 2007 to January 2018. Clinical details and investigations were recorded and analyzed. Results A total of 218 children (110 boys), with a median age of 10 (0.25-12) years, were included. There was a median delay of 4 (0.5-36) months in establishing the diagnosis. Abdominal pain, fever, and loss of weight were the most common presenting features, with the triad of symptoms present in 54%. Multiple intra-abdominal sites were involved in 118 (54%) patients, with a combination of the gastrointestinal tract (I) and abdominal lymph nodes (L) being the most common (53/118). Among children with single-site involvement (n = 100), the most commonly involved was L in 39 (39%), followed by I in 35(35%). Loss of weight was more common in children with involvement of multiple sites (85/118 vs 60/100, P = 0.03). Overall, a confirmed diagnosis was possible in 94 participants (43.1%). Suggestive imaging had the highest diagnostic yield of 85%. Nine (4.1%) patients needed surgical management. Conclusion A triad of abdominal pain, fever, and weight loss is suggestive of ATB. Multiple intra-abdominal sites are frequently involved. Microbiological confirmation is possible in only one-third of the cases.
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Affiliation(s)
- Sadhna B Lal
- Division of Paediatric Gastroenterology, Hepatology and Nutrition Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Rishi Bolia
- Division of Paediatric Gastroenterology, Hepatology and Nutrition Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Jagadeesh V Menon
- Division of Paediatric Gastroenterology, Hepatology and Nutrition Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Vybhav Venkatesh
- Division of Paediatric Gastroenterology, Hepatology and Nutrition Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Anmol Bhatia
- Division of Paediatric Gastroenterology, Hepatology and Nutrition Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Kim Vaiphei
- Department of Pathology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Rakesh Yadav
- FIND-RNTCP, Department of Microbiology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Sunil Sethi
- Department of Microbiology Post Graduate Institute of Medical Education and Research Chandigarh India
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8
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Ahamed Z R, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther 2019; 17:547-555. [PMID: 31293195 DOI: 10.1080/14787210.2019.1642746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Rizwan Ahamed Z
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Agarwala
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Ramos JM, Pérez-Butragueño M, Tesfamariam A, Reyes F, Tiziano G, Endirays J, Balcha S, Elala T, Biru D, Comeche B, Górgolas M. Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study. BMC Public Health 2019; 19:856. [PMID: 31266471 PMCID: PMC6604275 DOI: 10.1186/s12889-019-7206-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0–4 versus 5–14 years in rural Ethiopia. Methods For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5–14 years. Results We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5–14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5–14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5–14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5–14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5–14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002). Conclusions We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success. Electronic supplementary material The online version of this article (10.1186/s12889-019-7206-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- José M Ramos
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia. .,Department of Internal Medicine, Alicante General University Hospital, ISABIAL, Calle Pintor Baeza, 12, 03010, Alicante, Spain. .,Miguel Hernández University of Elche, Alicante, Spain.
| | - Mario Pérez-Butragueño
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,Department of Pediatrics, Infanta Leonor University Hospital, Madrid, Spain
| | - Abraham Tesfamariam
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Francisco Reyes
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Gebre Tiziano
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Jacob Endirays
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Seble Balcha
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Tamasghen Elala
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Dejene Biru
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Belén Comeche
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,National Referral Unit for Tropical Disease, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain
| | - Miguel Górgolas
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,Division of Infectious Diseases, Jiménez Diaz University Hospital Foundation, and Autonomic University of Madrid, Madrid, Spain
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10
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Matucci T, Galli L, de Martino M, Chiappini E. Treating children with tuberculosis: new weapons for an old enemy. J Chemother 2019; 31:227-245. [DOI: 10.1080/1120009x.2019.1598039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tommaso Matucci
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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11
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Cheng LJ, Zhang SC. Abdominal ascites in children as the presentation of eosinophilic gastroenteritis: A surgeon's perspective. Clin Res Hepatol Gastroenterol 2019; 43:e12-e17. [PMID: 30528318 DOI: 10.1016/j.clinre.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/03/2018] [Accepted: 11/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal ascites is a common problem in general surgery. The causes include parasitic diseases, tuberculosis, malignancies, hypoalbuminemia, abdominal inflammatory diseases, and peritonitis. Eosinophilic gastroenteritis (EG) has also been reported to be an infrequent cause. To our knowledge, most instances of abdominal ascites from EG have occurred in adults and been reported by physicians or gastroenterologists. Herein, we report a small series of children who presented with eosinophilic ascites from a surgeon's perspective. METHODS Five children with EG (male: 3; female: 2) were selected for review of medical data and diagnostic reports. RESULTS The patients typically presented with intermittent abdominal pain (n = 5), diarrhea and nausea (n = 2), abdominal distension (n = 2), fever (n = 2), and histories of allergic disease (n = 3). Peripheral eosinophilia was regularly noted, three children showing elevated IgE levels. Abdominal ultrasound and CT performed in each instance demonstrated abdominal ascites. Surgical intervention was elected in two patients. Dietary control and a methylprednisolone regimen were then instituted in all children, followed by full clinical remissions. After a regular follow-up, all patients are doing well. CONCLUSIONS Surgeons should be aware of EG as a rare cause of ascites, even in a pediatric population and especially in children with strong histories of allergic diseases, peripheral blood eosinophilia, and/or family histories of EG. It is important to avoid unnecessary surgical intervention, because dietary control and methylprednisolone treatment are effective remedies.
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Affiliation(s)
- Lan-Jie Cheng
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, 36, Sanhao Street, Heping district, Shenyang 110004, PR China
| | - Shu-Cheng Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, 36, Sanhao Street, Heping district, Shenyang 110004, PR China.
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12
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Pandit K, Khanal S, Bhatta S, Trotter AB. Anorectal tuberculosis as a chronic rectal mass mimicking rectal prolapse in a child-a case report. Ann Med Surg (Lond) 2018; 36:264-266. [PMID: 30568795 PMCID: PMC6287574 DOI: 10.1016/j.amsu.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/09/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis of the colon commonly involves the ascending,transverse, or sigmoid colon while rectal involvement in tuberculosis is uncommon and poorly characterized. We report a six-year-old male from Nepal who presented with abdominal pain and difficulty passing stool for two years. On per rectal examination, palpation revealed a circumferential rectal mass. On further evaluation, CT scan showed mural thickening and luminal narrowing in the ano-rectum. Colonoscopy with biopsy showed caseating granuloma and positive acid fast bacilli culture consistent with tuberculosis. After starting anti-tubercular therapy, the patient's abdominal pain resolved and the patient was able to pass stool normally within two weeks. Colonoscopy three months after starting treatment showed complete resolution of the mass. Gastrointestinal tuberculosis should be considered in cases of children from endemic areas who present with a rectal mass. Anorectal tuberculosis is a rare entity which can present as a chronic rectal mass. A high index of suspicion for tuberculosis is necessary in all pediatric patients from TB endemic areas with nonspecific abdominal signs and symptoms. When diagnosed early, with 6–12 months of therapy ano-rectal tuberculosis shows very good prognosis.
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