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Tuberculosis in the pediatric population of Houston, Texas
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.
Insights
Tuberculosis affects children, with diagnosis often from contact tracing. Shorter treatment regimens are effective, but compliance and drug resistance require careful management for successful outcomes in pediatric tuberculosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant pediatric health concern.
- Early diagnosis and effective treatment are crucial for preventing severe outcomes in children.
Purpose of the Study:
- To analyze the characteristics, diagnosis, treatment, and outcomes of active tuberculosis in children treated at a Houston clinic.
- To highlight challenges in pediatric TB management, including drug resistance and treatment compliance.
Main Methods:
- Retrospective review of 110 children with active tuberculosis treated between September 1984 and December 1987.
- Analysis of demographic data, diagnostic methods, disease sites, microbiological yield, drug resistance, treatment regimens, and compliance.
Main Results:
- The median age of affected children was 24 months, with a high proportion of Hispanic and black children.
- Diagnosis was primarily through contact investigation (50%) and evaluation of ill children (44%).
- Intrathoracic disease was most common (77%), but extrathoracic involvement occurred in 23%. Drug-resistant TB posed a critical threat, with delayed recognition impacting outcomes.
- A shortened therapy of 6-9 months was successful in 94% of patients, though 39% required supervised, twice-weekly treatment due to noncompliance.
Conclusions:
- Pediatric tuberculosis presents unique challenges requiring specialized expertise in diagnostics, drug selection, and ensuring treatment adherence.
- Effective management strategies, including shorter treatment durations and supervised therapy, can lead to high treatment success rates.
- Continued vigilance for drug resistance and prompt recognition are vital for improving pediatric TB patient outcomes.
Abstract:
From September 1984 to December 1987, the children's tuberculosis clinic in Houston, TX, cared for 110 children with active tuberculosis. The median age was 24 months. Approximately one half of the cases were in Hispanic children, but one third were in black children. Only 11% were foreign-born. Diagnosis resulted from case contact investigation in 50% of cases, routine tuberculin screening in 6%, and evaluation of an ill child in 44%. Intrathoracic disease alone was present in 77% of cases, and extrathoracic disease in 23%, including involvement of the cervical and supraclavicular lymph nodes, meninges, brain, liver, and skin. Gastric aspirates yielded Mycobacterium tuberculosis from 39% of the children with pulmonary disease. Of six children infected with drug-resistant tuberculosis, two became critically ill before referral because the probability of resistance was not recognized by the referring physician. Presently, 94% of patients have successfully completed therapy, which has been shortened from 12 to 18 months to 6 to 9 months. However, 39% were noncompliant with treatment and required twice-weekly supervised therapy to complete treatment. Tuberculosis remains a serious cause of morbidity in children; specific expertise in obtaining cultures, selecting drugs, and assuring compliance is crucial for adequate results.