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Pulmonary tuberculosis in Italian children by age at presentation
A Romano1, P Di Carlo, L Abbagnato
1Civico Hospital, ARNAS, Palermo, Italy.
Insights
Paediatric pulmonary tuberculosis (PTB) is more common in younger children, who are also more likely to have an identified source case. Early diagnosis and prompt treatment are crucial for managing childhood TB, especially in vulnerable young populations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Paediatric pulmonary tuberculosis (PTB) presents unique diagnostic and management challenges.
- Understanding age-related clinical characteristics is vital for effective PTB control in children.
Purpose of the Study:
- To evaluate the clinical characteristics, diagnostic methods, and outcomes of paediatric PTB.
- To analyze these factors in relation to children's ages.
Main Methods:
- Prospective evaluation of 62 children under 15 admitted with suspected PTB.
- Data collection included demographics, clinical signs, radiography, and microbiology.
- Contact investigations were performed to identify source cases.
Main Results:
- Children under 5 years old were more symptomatic and more likely to have an identified source case.
- Ghon complex was more frequent in younger children.
- Mycobacterium tuberculosis (MT) or MT DNA was detected in 23% and 32% of patients, respectively.
- Drug-resistant strains were identified in 5 children and 4 adult sources.
Conclusions:
- Improved case detection, management, and contact tracing are essential for controlling paediatric TB, particularly in young children.
- Identifying the source case is critical for appropriate treatment selection in paediatric TB.
Aim:
To evaluate the clinical characteristics, diagnostic methods and outcome of paediatric pulmonary tuberculosis (PTB) in relation to children's ages when observed.
Methods:
Children under 15, who had been admitted to the Children's Hospital with PTB were prospectively evaluated. Our sample included patients with a positive tuberculin skin test and signs or symptoms of tuberculosis (TB), including abnormal chest X-rays which suggested PTB. We collected demographic, clinical, radiographic and microbiological data from the patients, in addition to carrying out contact investigations in order to find a source case. All the patients involved in this study were subjected to anti-tuberculosis treatment.
Results:
Sixty-two patients (44% under 5) were eligible for inclusion in our study. Children with presenting symptoms were younger than asymptomatic patients (p<0.05). A source case was found in 38 patients out of 62 children (62%) and children under 5 were more likely to have a source case than that found with older children (p<0.05). Ghon complex (infiltrate + adenopathy) tended to occur in young children (median age of 3.25, p<0.05). Fourteen children (23%) had clinical specimens which tested positive for Mycobacterium tuberculosis (MT), and 20 (32%) for MT DNA according to a polymerase chain reaction (PCR). Resistant strains to 1 or more anti-tuberculosis drugs were found in 5 children and in 4 adult sources. The patients with minimal or no radiographic change during therapy displayed symptoms for a longer period of time and were infected by a resistant strain (p<0.05).
Conclusion:
Improvements in case detection, case management and contact investigations are necessary for controlling paediatric TB, especially in young children. Given that any diagnosis of TB in children is supported by epidemiological and clinical evidence rather than isolating MT, detection of the source case is important in selecting appropriate treatment.
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