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Pediatric pleural tuberculosis
Gulsum Iclal Bayhan1, Fuat Sayir2, Gonul Tanir3
1Department of Pediatric Infectious Diseases, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey.
International Journal of Mycobacteriology
|September 11, 2018
Summary
Pediatric pleural tuberculosis (TB) diagnosis can be challenging. Increased adenosine deaminase (ADA) levels in lymphocyte-predominant pleural effusions strongly suggest TB, even with uncomplicated effusions.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Diagnosing pleural tuberculosis (TB) in children presents challenges due to low microbiologic confirmation rates in pleural fluid.
- Limited case series focusing on pediatric pleural TB exist in the literature.
Observation:
- A retrospective review identified seven pediatric pleural TB cases.
- Over half the cases (57.1%) had concurrent pulmonary TB, while 42.9% presented with isolated pleural TB.
- Lymphocytic pleural effusion and elevated adenosine deaminase (ADA) levels (>40 U/L) were observed in 85.7% of patients.
Findings:
- Lymphocyte-predominant pleural effusions with increased ADA levels are highly indicative of TB in pediatric patients.
- Pleural TB can manifest as uncomplicated (transudate) effusion, not exclusively complicated (exudate) effusion.
- All seven pediatric patients recovered completely after a 6-month anti-TB medication regimen.
Implications:
- Elevated ADA levels in lymphocyte-predominant effusions can aid in diagnosing pediatric pleural TB, especially when microbiological confirmation is difficult.
- Clinical awareness of both uncomplicated and complicated effusion types in pediatric pleural TB is crucial for appropriate management.
- This case series contributes valuable data to the limited literature on pediatric pleural TB, informing diagnostic and treatment strategies.
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