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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.
Insights
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.
Abstract:
Tuberculosis (TB) remains a serious health problem in many developing countries. As impaired immunity is closely associated with the pathogenesis of TB, an increase in the incidence of this disease among patients with cancer is anticipated. This retrospective analysis of children from an area of high TB prevalence was done to determine the incidence of TB in children treated for cancer. Of 390 children admitted between 1983 and 1990, 278 were evaluated. Standardized morbidity ratios showed that children with malignancies had an 11-times greater chance of developing TB than children of the same age group in the general population. The highest incidence occurred in children with Wilms' tumour (5 of 41). In the majority of patients (77%), TB was diagnosed during the initial period of hospitalization and chest X-ray suggested post-primary TB. This suggests reactivation of quiescent mycobacteria during a period of impaired immunity. Children from an area with a high incidence of TB who develop malignancy should be actively investigated for tuberculosis prior to the start of immunosuppressive therapy. We speculate that these children would benefit from a course of preventive anti-tuberculosis treatment at the start of chemotherapy.