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Tuberculosis in infants: a retrospective study in China
Ruo-Lin Li1, Jun-Li Wang2, Xin-Feng Wang3
1Department of Medicine Research, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi People's Republic of China.
Insights
Infant tuberculosis (TB) in high-burden countries often presents as extrapulmonary TB, particularly lymphadenitis. Diagnostic tests show low sensitivity, highlighting the need for improved infant TB diagnostics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health challenge, especially in high-burden countries.
- Infant tuberculosis (TB) presents unique diagnostic and clinical challenges.
- Understanding the specific epidemiology of infant TB is crucial for effective control strategies.
Purpose of the Study:
- To describe the demographics, clinical characteristics, and microbiologic findings of infant tuberculosis (TB) in a high TB burden country.
- To evaluate the diagnostic performance of routine TB tests in infants.
- To identify common clinical presentations and sites of extrapulmonary TB (EPTB) in infants.
Main Methods:
- A retrospective review of 115 infants (≤2 years old) diagnosed with TB between February 2007 and June 2015.
- Analysis of demographic data, clinical presentations, and diagnostic test results (pathology, acid-fast bacilli smear, mycobacterial culture, PPD, T-SPOT.TB).
- Comparison of clinical characteristics and time to hospital admission across different TB types.
Main Results:
- The majority of infants were male (73.0%), with a mean age of 10.1 months.
- Extrapulmonary TB (EPTB) was more common (64.4%) than pulmonary TB, with tuberculous lymphadenitis (61 cases) being the most frequent site, particularly axillary lymph nodes (54 cases).
- Routine TB diagnostic tests demonstrated low sensitivity (e.g., mycobacterial culture 26.2%, PPD 49.2%, T-SPOT.TB 46.7%).
Conclusions:
- Infant TB in this high-burden setting is predominantly extrapulmonary, with a high proportion of tuberculous lymphadenitis.
- The low sensitivity of conventional TB diagnostic tests in infants underscores the urgent need for improved diagnostic tools.
- An association between axillary lymph node TB and BCG vaccination in infants in China warrants further investigation.
Abstract:
To describe the demographics, clinical characteristics and microbiologic findings of infant (≤2 years old) tuberculosis (TB) in a high TB burden country. Between Feb, 2007 and Jun, 2015, 115 TB infants who admitted to our hospital were enrolled in the study. Their clinicopathological characteristics were reviewed and analyzed. The mean age was 10.1 ± 7.4 (SD) months, and 84 of 115 infants (73.0 %) were males. 23 patients (20.0 %) had isolated pulmonary TB, 18 patients (15.7 %) had pulmonary and extrapulmonary TB (EPTB), the remaining 74 patients (64.4 %) had exclusively EPTB. The most common site of EPTB was lymph node (n = 61), 54 cases were left axillary lymph node involvement. 49 of 51 patients (96.1 %) were validated by pathological examination, 5 of 57 patients (8.8 %) were positive on acid fast bacilli smear, and 27 of 103 patients (26.2 %) were confirmed by mycobacterial culture. 29 of 59 patients (49.2 %) were PPD positive, 14 of 30 patients (46.7 %) were T-SPOT.TB positive. The most common complaints of patients were lymph node swelling (53.0 %), fever (36.5 %), cough (28.7 %) and dyspnea (10.4 %). There was significant difference in the time before hospital admission among different types of tuberculosis (P < 0.01), fever was also a factor influencing the time (P < 0.05). In infants, the sensitivities of routine TB tests were low and emphasize the need for improved diagnostics; EPTB was more common than pulmonary TB, tuberculous lymphadenitis constituted a high proportion of EPTB; there appears to be an association between the incidence of axillary lymph node TB and BCG vaccination among infants in China.
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