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Clinical profile and treatment outcome of tubercular pleurisy in pediatric age group using DOTS strategy
Sangeeta Sharma1, Rohit Sarin, U K Khalid
1LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi - 110 030.
Insights
The Directly Observed Treatment, Short-course (DOTS) strategy effectively treats pediatric tubercular pleurisy, achieving a high completion rate. Early detection through simple tests is crucial for successful outcomes in childhood tuberculosis.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Public Health
Background:
- Childhood tuberculosis (TB) represents a significant global health burden, with extrapulmonary TB (EPTB) posing particular management challenges.
- Pediatric tubercular pleurisy requires effective treatment strategies to improve patient outcomes.
Purpose of the Study:
- To evaluate the demographic and clinical characteristics of pediatric tubercular pleurisy.
- To assess the treatment outcomes of the Directly Observed Treatment, Short-course (DOTS) strategy in managing pediatric tubercular pleurisy.
Main Methods:
- A retrospective analysis was conducted on 106 children diagnosed with TB pleurisy and treated using the DOTS strategy.
- Diagnostic methods included conventional tests (Mantoux, radiography, ultrasound, pleural aspiration) and minimally invasive procedures (percutaneous pleural biopsy).
Main Results:
- Fever (98.1%), cough (77.4%), and chest pain (55.7%) were the most common symptoms.
- Unilateral effusion was prevalent (61.3%), with exudative and lymphocytic pleural fluid observed in most cases.
- The DOTS strategy demonstrated a high treatment completion rate (94.3%) with low default (4.7%) and failure (0.9%) rates, and no reported deaths.
Conclusions:
- The study highlights the effectiveness of the DOTS strategy in treating pediatric tubercular pleurisy.
- Early diagnosis utilizing simple diagnostic tools, coupled with adherence to the DOTS strategy, is essential for successful management of childhood TB.
Background:
A significant proportion of global tuberculosis (TB) caseload is contributed by children. Management of pediatric TB especially EPTB is challenging. The present study was designed to study demographic, clinical profile and treatment outcome of DOTS strategy for pediatric tubercular pleurisy.
Aim:
To study the efficacy of DOTS strategy.
Methods:
Retrospective analysis of 106 TB pleurisy children treated with DOTS.
Results:
Mean age was 10.8 years (median age 12.2 years) with more females (51.9%) than males (48.1%) chi1(2) = 0.15; P = 0.698 (NS). In the age group of 0-5, 6-10 and 11-14 years, there were 15.1%, 30.2% and 54.7% patients respectively. Fever was the commonest symptom (98.1%) followed by cough (77.4%) and chest pain (55.7%). History of contact could be elicited only in 2/3rd of cases unilateral effusion (61.3%) was commonest, followed by empyema (22.6%), massive effusion and broncho-pleural fistula each in 13.2% cases respectively. Bilateral effusion was seen in 3.8% cases only. Conventional methods (mantoux, radiograph, ultrasound, pleural aspiration) and minimal invasive surgical techniques, percutaneous pleural biopsy were done to arrive at the diagnosis. Diagnosis was made by X-ray Chest in 92.5%, exudative pleural fluid (100%) predominantly lymphocytic in 85.8%, positive AFB smear and culture in 4.7 and 5.7% cases respectively. Category I, II and III was started on 35.9%, 2.8% and 61.3% patients respectively. Overall treatment completion rate was 94.3%, 4.7% default rate, 0.9% failure rate and no deaths.
Conclusion:
The study confirms early detection by simple tests and ensuring complete treatment using DOTS strategy.
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