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The increased risk of developing tuberculosis in children with malignancy
G Wessels1, P B Hesseling, R P Gie
1Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Hospital, South Africa.
Annals of Tropical Paediatrics
|January 1, 1992
Summary
Children with cancer in high tuberculosis (TB) prevalence areas face an 11-times higher risk of developing TB. Early investigation and preventive treatment are crucial for these vulnerable pediatric oncology patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) is a significant global health issue, particularly in developing nations.
- Impaired immunity is a key factor in TB pathogenesis.
- Cancer treatment often involves immunosuppression, increasing susceptibility to infections like TB.
Purpose of the Study:
- To determine the incidence of tuberculosis in children undergoing cancer treatment in a high TB prevalence area.
- To assess the risk of TB development in pediatric cancer patients compared to the general population.
Main Methods:
- Retrospective analysis of 278 children treated for cancer between 1983 and 1990.
- Calculation of standardized morbidity ratios (SMRs) to compare TB incidence.
- Review of diagnostic methods, including chest X-rays.
Main Results:
- Children with malignancies had an 11-fold increased risk of developing TB.
- Wilms' tumour showed the highest incidence among specific cancers.
- Tuberculosis was diagnosed during initial hospitalization in 77% of cases, often presenting as post-primary TB, suggesting reactivation.
Conclusions:
- Pediatric cancer patients in high TB prevalence areas are at substantially elevated risk for tuberculosis.
- Active TB investigation is recommended before initiating immunosuppressive therapy in these children.
- Preventive anti-tuberculosis treatment at the start of chemotherapy may benefit these patients.