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Published on: March 10, 2017
Tuberculosis in the paediatric population of Madrid in the last 26 years
Arantxa Berzosa Sánchez1, Marta Illán Ramos1, María Prados2
1Servicio de Pediatría, Hospital Clínico San Carlos, Madrid, España.
Insights
Diagnosing tuberculosis (TB) in children is challenging. This study found pulmonary TB is most common in Spanish children, often diagnosed presumptively, highlighting the need for contact tracing to control spread.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) remains a significant global health issue, particularly challenging to diagnose in pediatric populations.
- Children under two years old face the highest risk for severe and disseminated forms of TB.
- Pulmonary tuberculosis is the predominant form in children.
Purpose of the Study:
- To characterize the epidemiology and clinical presentation of tuberculosis in children in Spain.
- To analyze diagnostic methods, treatment, and outcomes for pediatric TB cases.
Main Methods:
- Retrospective analysis of pediatric TB cases diagnosed between 1991 and 2017 in Madrid, Spain.
- Inclusion of 170 pediatric patients, examining epidemiological, clinical, and treatment data.
- Evaluation of diagnostic test results, including Mantoux tuberculin skin test and Interferon-Gamma Release Assay (IGRA).
Main Results:
- The study identified 170 pediatric TB cases, with peak incidence in infancy and adolescence.
- Immigrant children comprised 42.9% of cases; common reasons for consultation included TB contact and fever.
- Pulmonary TB was prevalent (91.8%), with positive Mantoux (92.2%) and IGRA (70.6%) tests. Three isoniazid-resistant strains were identified. All patients were cured except one fatality.
Conclusions:
- Pulmonary tuberculosis is the most common form in children, often diagnosed presumptively based on symptoms and diagnostic tests.
- Contact investigation is crucial for controlling the spread of pediatric tuberculosis.
- Early diagnosis and treatment are vital for favorable outcomes in pediatric TB.
Introduction:
Tuberculosis (TB) continues to be a serious public health problem and establishing a definitive diagnosis among children is extremely challenging. Pulmonary tuberculosis is the most prevalent form, with children under the age of 2 years being at greatest risk of severe and disseminated forms. The aim of this study was to describe TB among children in Spain in recent years.
Patients And Methods:
A retrospective study of paediatric patients diagnosed with TB in two hospitals of the Community of Madrid over a 26-year period (1991-2017). Epidemiological and clinical variables, additional tests and treatments received were analysed.
Results:
170 children were included. The two most-affected age groups were infancy and adolescence. 42.9% of patients were immigrant children (South-America or Morocco). The main reasons for consultation were TB contact (20.6%) and fever (15.3%). At diagnosis, 61.8% of cases referred an epidemic environment, and 30.6% were asymptomatic. The Mantoux tuberculin skin test was positive in 92.2% of patients and IGRA was positive in 70.6%. Pulmonary TB was identified in 91.8% of children vs. 8.2% with extrapulmonary forms. Gastric juice culture was positive in 36.9% of cases and three strains resistant to isoniazid were isolated. All patients were cured without complications except one who died.
Conclusions:
Pulmonary TB continues to be the most prevalent form among children and presumptive diagnosis (symptoms consistent with positive Mantoux test or suggestive X-ray) is the most common form of diagnosis. It is important to conduct a contact investigation in order to control the spread of TB.
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