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Published on: October 25, 2024
Patterns and Outcomes in Pediatric Abdominal Tuberculosis: A Single Centre Cohort Study
Susan John1, Dhruva Ghosh2, Vishal Michael3
1NIHR Health Research Unit on Global Surgery, India Hub, Christian Medical College, Ludhiana, Punjab, India.
Insights
Abdominal tuberculosis in children requires high clinical suspicion for diagnosis. Intestinal involvement and older age are linked to increased mortality, highlighting the need for targeted research in pediatric abdominal TB.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Global health
Background:
- Abdominal tuberculosis (TB) diagnosis and treatment can be challenging, especially in children.
- Limited studies focus on pediatric abdominal TB outcomes and risk factors for adverse events.
Purpose of the Study:
- To evaluate treatment response and identify factors associated with poorer outcomes in children with abdominal TB.
- To analyze the presentation, management, and outcomes of pediatric abdominal TB.
Main Methods:
- Retrospective analysis of 75 pediatric abdominal TB cases from 2007-2021.
- Data collected via questionnaire and follow-up (in-person or telephonic).
- Evaluated demographic features, symptoms, investigations, treatment, and outcomes.
Main Results:
- Abdominal TB incidence was 7% in all TB cases; mean age was 10.1 years.
- Mesenteric lymph nodes (67%) and small intestine (33%) were common sites.
- Older age, small intestine involvement, and surgery were associated with higher mortality (6/70 deaths).
Conclusions:
- Intestinal involvement necessitates surgery and increases mortality risk in pediatric abdominal TB.
- Adolescents with abdominal TB experience poorer outcomes.
- Further research on specific subgroups is needed to improve prevention and treatment strategies.
Introduction:
Abdominal tuberculosis presents in a variety of ways. Different testing modalities must be applied in addition to having a high clinical suspicion to diagnose and initiate therapy. Medications have a good response; however, morbidity has been seen following surgical management of complicated presentations like intestinal obstruction and perforation. There is a paucity of studies in the pediatric age group which evaluate response to the different treatment regimen and identify factors associated with poorer outcomes in children with abdominal tuberculosis.
Methods:
Patient records of 75 children with abdominal tuberculosis at a single center were evaluated using a questionnaire, covering a 14-year period from 2007 to 2021. Demographic features, presenting signs and symptoms, investigations and treatment details were studied. In- person or telephonic follow-up was conducted to identify treatment outcomes.
Results:
Incidence of abdominal TB was 7%, of all TB children with a mean age of 10.1 years. Mesenteric lymph nodes were involved in 67% and small intestine in 33% cases. Surgery was required in 22 children. 85% children completed treatment. Small intestine involvement had higher probability of undergoing surgery. Of the 70 children with complete follow up, 64 were well and 6 children succumbed to the disease. Older age, small intestine involvement and surgery were independently associated with higher mortality.
Conclusion:
Intestinal involvement is associated with greater need for surgical intervention and greater mortality. Adolescents have poorer outcomes. Further studies are required focusing on these individual subgroups to understand the patterns of presentation, causes for mortality and prevention.
Level Of Evidence:
Level 5.
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