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Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children
Melanie M Dubois1,2, Meredith B Brooks2, Amyn A Malik3,4
1From the Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts.
Insights
Extrapulmonary tuberculosis (EPTB) in children presents variably, often delaying diagnosis. This study in Pakistan identified age-specific risk factors like weight loss for EPTB, aiding timely diagnosis and improved outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Extrapulmonary tuberculosis (EPTB) in children often presents with nonspecific symptoms, leading to diagnostic delays and adverse outcomes.
- Timely diagnosis of EPTB in pediatric populations is crucial for effective management and improved prognosis.
Purpose of the Study:
- To describe the age-specific clinical presentation of extrapulmonary tuberculosis (EPTB) in children.
- To identify risk factors associated with EPTB in different pediatric age groups in Pakistan.
Main Methods:
- A cross-sectional study was conducted in four facilities in Sindh, Pakistan, between 2015-2016.
- Children diagnosed with TB were assessed for EPTB based on bacteriologic confirmation or clinical-radiologic criteria, excluding pulmonary TB.
- Age-specific regression analyses were performed to identify factors associated with EPTB in children aged 0-4, 5-9, and 10-14 years.
Main Results:
- Out of 1163 children with TB, 157 (13.5%) had EPTB, with the most common sites being lymph nodes (72.4%) and abdomen (19.9%).
- Weight loss was a significant risk factor for EPTB in children aged 0-4 years (aOR: 2.80) and 10-14 years (aOR: 2.79).
- The presence of cough was associated with a decreased risk of EPTB.
Conclusions:
- This study provides valuable insights into the age-specific clinical manifestations and risk factors of EPTB in Pakistani children.
- The findings can inform the development of optimized clinical algorithms for earlier EPTB diagnosis in children.
- Improved diagnostic strategies are expected to lead to better treatment outcomes for pediatric EPTB.
Background:
Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan.
Methods:
In 2015-2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0-4, 5-9 and 10-14 years.
Results:
A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0-4, 53 (33.8%) were 5-9 and 58 (36.9%) were 10-14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0-4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05-7.47) and 10-14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28-6.07) groups, and the presence of cough was associated with a decreased risk of EPTB.
Conclusions:
This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.
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