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Miliary tuberculosis in children. A clinical review
1Department of Child Health, Medical School, University of Indonesia, Jakarta.
Abstract:
Eighty cases of miliary tuberculosis admitted to our hospital between January 1981 and December 1984 were reviewed. The age of the patients ranged from 3 months to 12 years, with an average of 2 years 2 months (26.5 months). Nine cases (11.25%) died during hospitalization due to the severe condition at the time of admission. Only 8 patients (10%) were in good nutritional condition. Seventy-two patients (90%) had been visiting the primary health care clinic for several times since 2-3 months but were never diagnosed as suffering from tuberculosis. Fever or recurrent fever were found in 78 cases (97.5%), anorexia in 65 cases (81.3%), chronic and/or recurrent cough in 72 cases (90%) and malaise in 43 (53.8%). Forty-one (51.3%) denied the presence of a close contact with source of infection. Hepatomegaly was found in 44 cases (55%), 19 (23.8%) of which were associated with splenomegaly. Choroidal tubercle was found in 4 cases; 1 case with coxitis, 1 with brain tuberculoma, 1 with ascites, 1 with endobronchitis and 1 with hepatitis. Forty-three (53.8%) were tuberculin negatives, 24 of which become positives after treatment. Fourteen cases had BCG scar. History of measles was found in 21 cases. Children with longterm and recurrent fever, anorexia, decrease of body weight and recurrent cough should be suspected of having TB thus enabling to get an early diagnosis.
Insights
Miliary tuberculosis in children is often misdiagnosed, with 90% of cases missed by primary care. Early suspicion of symptoms like prolonged fever and cough is crucial for timely diagnosis and treatment of this severe childhood disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Miliary tuberculosis (TB) is a severe disseminated form of TB.
- Pediatric TB diagnosis is challenging, often leading to delayed treatment.
- This study reviews cases of miliary TB in children admitted to a hospital.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic challenges, and outcomes of miliary tuberculosis in children.
- To highlight the importance of early recognition and diagnosis of pediatric miliary TB.
Main Methods:
- Retrospective review of 80 pediatric miliary tuberculosis cases admitted between 1981 and 1984.
- Analysis of patient demographics, clinical presentations, diagnostic findings, and treatment outcomes.
Main Results:
- The average age was 2 years and 2 months; 11.25% of patients died.
- 90% of children had visited primary care multiple times without a TB diagnosis.
- Common symptoms included recurrent fever (97.5%), anorexia (81.3%), and chronic cough (90%).
- Hepatomegaly (55%) and splenomegaly (23.8%) were frequent findings.
- 53.8% were initially tuberculin negative, with 24 converting to positive after treatment.
Conclusions:
- Miliary tuberculosis in children presents with non-specific symptoms, leading to diagnostic delays.
- Primary healthcare providers must suspect TB in children with prolonged fever, anorexia, and cough.
- Early diagnosis and intervention are critical for improving outcomes in pediatric miliary TB.