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Paediatric abdominal tuberculosis in developed countries: case series and literature review
Megan Delisle1, Jade Seguin2, David Zeilinski3
1McGill University, Montreal, Canada.
Insights
Paediatric abdominal tuberculosis (TB) in developed countries often affects immigrant and aboriginal children. Diagnosis relies on clinical signs, imaging, and biopsies, guiding conservative management.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Public health
Background:
- Paediatric abdominal tuberculosis (TB) is uncommon in developed countries.
- Understanding its presentation, diagnosis, and management is crucial for timely intervention.
Observation:
- A case series and literature review identified common clinical features including abdominal pain, fever, and weight loss.
- Imaging revealed gastrointestinal TB with colonic wall irregularity and peritoneal TB with ascites.
- Tuberculin skin tests were positive in 90% of cases.
Findings:
- Diagnosis was aided by imaging (ultrasound/CT) and tissue sampling via aspiration or biopsy.
- Surgical intervention was performed in 76% of cases, often for diagnostic purposes.
- Cultures confirmed TB in 73% of patients.
Implications:
- Clinical presentation combined with imaging-guided biopsies can support a conservative management approach for paediatric abdominal TB.
- Early diagnosis and appropriate management are essential to improve outcomes in affected children.
Objective:
To provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries.
Methods:
The records of all children at the Montreal Children's Hospital (MCH) admitted with abdominal TB between 1990 and 2014 were reviewed. An automated and manual literature search from 1946 to 2014 was performed.
Results:
(1) CASE SERIES: six cases were identified at the MCH. All were male between 5 and 17 years of age. All were from populations known to have high rates of TB (aboriginal, immigrant). Three underwent major surgical interventions and three underwent ultrasound (US) or CT aspiration or biopsy for diagnosis. (2) LITERATURE REVIEW: 29 male (64%) and 16 female subjects (36%) aged between 14 months and 18 years were identified, including the MCH patients. All patients except one were from populations with a high incidence of TB. Most presented with a positive tuberculin skin test (90%), abdominal pain (76%), fever (71%) and weight loss (68%). On imaging, 22 (49%) were classified with gastrointestinal TB with colonic wall irregularity (41%) and 19 (42%) with peritoneal TB with ascites (68%). A positive culture was obtained in 33 (73%) patients. Three cases used CT- or US-guided aspiration or biopsy to obtain tissue samples. A surgical intervention was performed in 34 (76%) children; 13 (38%) of these were for diagnosis.
Conclusions:
Diagnosis based on clinical features (abdominal pain, fever and weight loss) and CT- or US-guided aspiration or biopsy may encourage physicians to adopt a more conservative approach to abdominal TB.
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