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Published on: September 5, 2017
Comparative analysis of pediatric pulmonary and extrapulmonary tuberculosis: A single-center retrospective cohort
Hussein Hamdar1, Ali Alakbar Nahle1, Jamal Ataya2
1Faculty of Medicine, Damascus University, Damascus, Syria.
Insights
Extrapulmonary tuberculosis (EPTB) is more common than pulmonary tuberculosis (PTB) in hospitalized Syrian children. EPTB, especially TB meningitis, is linked to higher mortality, necessitating improved pediatric TB diagnosis and management strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) remains a significant global health concern, causing substantial morbidity and mortality.
- Pediatric TB presents unique challenges in diagnosis and management, particularly in resource-limited settings.
- Extrapulmonary tuberculosis (EPTB) often has a more complex presentation than pulmonary tuberculosis (PTB).
Purpose of the Study:
- To investigate the epidemiology, clinical features, diagnostic approaches, and early mortality of pediatric TB in a Syrian hospital.
- To differentiate characteristics and outcomes between PTB and EPTB in hospitalized children.
- To identify challenges and inform strategies for improving pediatric TB care in conflict-affected regions.
Main Methods:
- Retrospective cohort study of pediatric TB patients (January 2013-January 2023) at a University Children's Hospital in Syria.
- Data collection from medical records, including demographics, diagnostics, clinical presentation, chest radiography, and outcomes.
- Statistical analysis using SPSS version 25 to compare PTB and EPTB groups.
Main Results:
- 129 pediatric TB cases: 26.4% PTB, 73.6% EPTB (most common: lymphatic, gastrointestinal).
- PTB patients more likely to have cough and abnormal chest X-rays; EPTB patients more likely to have lymphadenopathy.
- Overall mortality 14%, higher in EPTB (16.8%), especially TB meningitis. Microbiological confirmation higher in PTB.
Conclusions:
- EPTB is predominant in hospitalized pediatric TB cases in Syria, posing diagnostic and management complexities.
- Higher mortality in EPTB underscores the need for enhanced diagnostic and treatment strategies.
- Improved contact tracing and awareness of diverse clinical presentations are crucial for pediatric TB diagnosis, particularly in challenging environments.
Background:
Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria.
Methods:
This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25.
Results:
A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis.
Conclusion:
Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.
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