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Hamdar H, Nahle AA, Ataya J, Jawad A, Salame H, Jaber R, Kassir M, Wannous H. Comparative analysis of pediatric pulmonary and extrapulmonary tuberculosis: A single-center retrospective cohort study in Syria. Heliyon 2024; 10:e36779. [PMID: 39263060 PMCID: PMC11387373 DOI: 10.1016/j.heliyon.2024.e36779] [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: 09/19/2023] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
Background Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria. Methods This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25. Results A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis. Conclusion Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.
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Affiliation(s)
- Hussein Hamdar
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Syria
| | - Ali Jawad
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hadi Salame
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rida Jaber
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Hala Wannous
- Pediatric Nephrology, Head of the Department of Pediatric Nephrology, Hemodialysis and Kidney Transplantation in Children's University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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Fong J, Chia DSY, Chew DEM, Wong KPL. Isolated remote site musculoskeletal Mycobacterium bovis infections after BCG immunisation in immunocompetent children. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:514-518. [PMID: 39230319 DOI: 10.47102/annals-acadmedsg.202449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
The Bacillus Calmette–Guerin (BCG) vaccine, derived from wild-type Mycobacterium bovis, is administered in an attenuated form to prevent Mycobacterium tuberculous (MTB) infections in children residing in endemic regions. Since the introduction of the Singapore Tuberculosis Elimination Programme in 1997—specifying mandatory BCG-immunisation at birth—the incidence fell drastically to 32.6 per 100,000 population in 2021,1 with the paediatric population contributing 2.1% of infections.2
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Affiliation(s)
- Jiawen Fong
- Department of Hand & Reconstructive Microsurgery, Sengkang General Hospital, Singapore
| | - Dawn Sinn Yii Chia
- Department of Hand & Reconstructive Microsurgery, Sengkang General Hospital, Singapore
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
| | - Darryl Ee Ming Chew
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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Sinnathamby A, Ang S, Bagdasarian N, Chan HC, Chan SM. Low uptake of isoniazid window prophylaxis in patients exposed to a health-care worker with pulmonary tuberculosis in a paediatric ward. J Paediatr Child Health 2021; 57:1408-1413. [PMID: 33847414 DOI: 10.1111/jpc.15490] [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: 10/26/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
AIM A nurse on a paediatric multidisciplinary ward was diagnosed with smear-positive pulmonary tuberculosis. Children <2 years old, immunocompromised, or >40 h of contact (n = 173) were contact-traced. METHODS Children received clinical review, chest X-ray, tuberculin skin test (TST; <5 years old) and/or an interferon-gamma release assay (Quantiferon TB-Gold, ≥5 years old). Infants <6 months old or children <5 years old screened <2 months from exposure were recommended isoniazid window prophylaxis (WP) until a repeat TST at 6 months old or 8-10 weeks after the last exposure to the index case, respectively. Empiric treatment for latent tuberculosis infection (LTBI) was individually considered for immunocompromised patients. RESULTS Of 173 children (135 immunocompetent, 38 immunocompromised), two were uncontactable, seven refused screening and two immunocompromised children excluded. Eight of 126 immunocompetent children were diagnosed with LTBI (initial TST positive n = 7, TST conversion n = 1); seven started isoniazid. Thirty-two of 36 immunocompetent children were recommended WP; 15 accepted (one non-compliant after 1 month). Six of seven immunocompromised children accepted empiric LTBI treatment due to severe immunosuppression/initial indeterminate Quantiferon TB-Gold result. Of 15 immunocompromised children offered WP, only five accepted. CONCLUSIONS There was high acceptance of screening but low uptake of isoniazid WP in high-risk children exposed to pulmonary tuberculosis. Perception of exposure risk and chemoprophylaxis should be explored further.
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Affiliation(s)
- Annushkha Sinnathamby
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore
| | - Samantha Ang
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore
| | - Natasha Bagdasarian
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infection Prevention, National University Hospital, Singapore
| | - Hwang Ching Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si Min Chan
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Comparison of clinical and laboratory profile of pulmonary and extrapulmonary tuberculosis in children: A single-center experience from India. J Clin Transl Res 2021; 7:423-427. [PMID: 34667887 PMCID: PMC8520702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Pediatric tuberculosis (TB) is an indicator of the recent transmission of TB in the community. However, the diagnosis of pediatric TB poses a challenge to clinicians. AIMS We aimed to evaluate and compare the clinical and laboratory profile of pulmonary TB (PTB) and extra PTB (EPTB) in children and adolescents. METHODS In this retrospective observational study, children attending the pediatric TB clinic of All India Institute of Medical Sciences, Rishikesh, from August 2015 to July 2017 were included in the study. The medical case records of patients were reviewed for demography, clinical findings, investigations, and diagnosis. The clinical and laboratory characteristics of patients with PTB and EPTB were compared. RESULTS A total of 58 children included. Out of which, 33 (56.9%) had PTB, and 25 (43.1%) had EPTB. The EPTB cases included 15 (60%) pleural TB, 9 (36%) lymph node TB, and 1 (4%) TB meningitis patient. Fever, cough, and weight loss were the most common symptoms. Hilar lymphadenopathy was the most common radiological abnormality. Microbiological confirmation was possible in 54.5% of patients with PTB. Cough (aOR 70.326; 95% CI: 5.370-921.032) and microbiological confirmation (aOR 46.011; 95% CI: 2.073-1021.201) were more in PTB as compared to EPTB. CONCLUSIONS PTB and EPTB are common in children and adolescents. The typical clinical manifestations and positive microbiological confirmation are less common in EPTB than PTB. RELEVANCE FOR PATIENTS TB is one of the common communicable diseases in the developing world. Diagnosis of TB in children is often challenging. Our study results help in better understanding childhood TB and EPTB clinical features and have potential to increase diagnostic yield.
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Khantee P, Laoprasopwattana K. Comparing Treatment Outcomes between Confirmed and Non-Confirmed Childhood TB Cases: Study from a Major Tertiary Center in Thailand. J Trop Pediatr 2021; 67:6075108. [PMID: 33421067 DOI: 10.1093/tropej/fmaa125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tuberculosis (TB) in children is challenging to diagnose due to its non-specific symptoms and difficulties in obtaining confirmatory laboratory results. This study aimed to compare the treatment outcomes of confirmed and non-confirmed TB in children. METHODS The medical records of children aged ≤ 15 years diagnosed with TB at Songklanagarind Hospital from January 2007 to December 2018 were examined. The TB cases were classified into three groups, confirmed cases (positive culture and/or polymerase chain reaction), probable cases (positive histopathological and/or acid-fast bacilli results) and presumptive cases (clinical manifestations and imaging findings compatible with TB and good response to anti-TB drugs but without microbiological confirmation). RESULTS Of 177 children, 66 (37.3%) had a confirmed diagnosis, 57 (32.2%) a probable diagnosis, and 54 (30.5%) a presumptive diagnosis. The successful treatment rates of the confirmed, probable and presumptive TB groups were 80.3%, 87.7% and 92.6%, respectively (p = 0.21). Of the 54 presumptive cases, a history of household contact with TB led to a diagnosis of asymptomatic pulmonary TB in 10 (18.5%) cases. Patients with a presumptive diagnosis were less likely to have disseminated and/or miliary TB (1.9% vs. 7.0% of probable vs. 22.7% of confirmed, p < 0.01). CONCLUSIONS Only one-third of the study patients had a confirmed TB diagnosis. The successful treatment and mortality rates did not significantly differ among the three groups. To increase the detection rate of early diagnosis of childhood TB, physicians should perform active TB contact investigations in household members of the index case.
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Affiliation(s)
- Puttichart Khantee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Kamolwish Laoprasopwattana
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Wong SA, Lee Meijuan D, Loh SW, Thoon KC, Tan NWH, Chong CY. Pediatric Abdominal Tuberculosis in Singapore: A 10-Year Retrospective Series. Glob Pediatr Health 2020; 7:2333794X20903952. [PMID: 32076630 PMCID: PMC7003167 DOI: 10.1177/2333794x20903952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background. Tuberculosis (TB) remains a major cause of mortality and morbidity globally. Pediatric patients are more likely to develop severe disease. Abdominal TB is a rare manifestation of pediatric TB and can present with chronic and nonspecific abdominal symptoms. This study examines the clinical profile of pediatric patients with abdominal TB and treatment outcomes. Method. A retrospective study of patients admitted to a tertiary pediatric hospital in Singapore over 10 years. Clinical characteristics and outcomes were examined. Results. There were 3 male and 3 female patients with mean age of 11.3 years. Household contacts were traced in 3 cases. The most common presenting symptoms were fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Inflammatory markers were raised with mean C-reactive protein (CRP) and erythrocyte sedimentation (ESR) rate at 70.9 mg/L and 90 mm/h respectively. Abdominal imaging showed abnormalities such as splenic foci and thickened bowel wall with significant intraabdominal lymphadenopathy. Mycobacterium tuberculosis was isolated from stool, rectal swabs and intra-adominal specimens. Two patients underwent excisional biopsy of lymph node to obtain diagnosis. Two patients required emergency laparotomy and 1 patient received esophagogastroduodenoscopy and colonoscopy. Four out of the 6 patients had pulmonary involvement. Conclusion. Abdominal TB should be a differential diagnosis in children with chronic abdominal symptoms for at least 8 weeks with anemia, raised ESR and CRP. The gold standard for diagnosis still remains as positive microbiological culture. However, abdominal imaging studies are also vital in obtaining further supportive evidence for chronic infection.
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Affiliation(s)
| | - Dawn Lee Meijuan
- KK Women’s and Children’s Hospital, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Sin Wee Loh
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Koh Cheng Thoon
- KK Women’s and Children’s Hospital, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Natalie Woon Hui Tan
- KK Women’s and Children’s Hospital, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Nanyang Technological University, Singapore, Singapore
| | - Chia Yin Chong
- KK Women’s and Children’s Hospital, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Nanyang Technological University, Singapore, Singapore
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