Clinical presentation of pediatric tuberculous spondylitis in high TB burden setting before and during the COVID-19 pandemic
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Nazhira P Juslin1, Djatnika Setiabudi2, Heda M Nataprawira2
1Bachelor of Medicine, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Sumedang, Indonesia.
Insights
The coronavirus disease (COVID-19) pandemic minimally impacted the clinical presentation of childhood tuberculous spondylitis (TBS). However, delayed diagnosis and severe symptoms at presentation highlight the need for improved primary care access for pediatric TB patients.
Area of Science:
- Pediatric infectious diseases
- Spinal infections
- Public health and epidemiology
Background:
- Tuberculous spondylitis (TBS) in children presents unique challenges due to its severity and slow progression.
- The coronavirus disease (COVID-19) pandemic disrupted tuberculosis (TB) services globally, necessitating an evaluation of its impact on pediatric TBS cases.
Purpose of the Study:
- To compare the clinical presentation of pediatric tuberculous spondylitis (TBS) before and during the COVID-19 pandemic.
- To assess the impact of pandemic-related service disruptions on the diagnosis and severity of TBS in children.
Main Methods:
- An analytic retrospective study analyzed medical records of pediatric patients (≤18 years) diagnosed with TBS.
- Data collected included demographic information, clinical features, diagnostic examinations, and treatment regimens.
- Statistical analysis was performed to compare outcomes between pre-pandemic and pandemic periods (p < 0.05).
Main Results:
- Common symptoms like gibbus, back pain, and inability to walk showed no significant difference between the two periods.
- A trend towards more frequent involvement of three or more vertebrae was observed during the pandemic (p=0.09).
- The median time from symptom onset to diagnosis was notably longer during the pandemic (21 weeks vs. 13 weeks, p=0.07).
Conclusions:
- The COVID-19 pandemic had a limited direct effect on the initial clinical symptoms of pediatric TBS.
- Most children presented with severe disease, indicating delays in seeking or receiving care at primary healthcare facilities.
- Early diagnosis and prompt initiation of treatment are critical for managing pediatric tuberculous spondylitis, especially during public health crises.
Introduction:
Tuberculous spondylitis (TBS) in children can be severe, non-specific, and slowly progressive. Disruptions in tuberculosis (TB) services were observed amid the coronavirus disease (COVID-19) pandemic, prompting a closer examination of its impact on TBS patients. This study compared the presenting symptoms of TBS in children before (A) and during (B) the pandemic.
Methodology:
An analytic retrospective study was conducted using medical charts and the pediatric respirology registry of all patients (aged ≤ 18 years) diagnosed with TBS before and after the pandemic. Demographic data, clinical features, confirmatory examination, and treatments were analyzed. Statistical significance was determined at p < 0.05.
Results:
The common presenting symptoms before and after the pandemic were gibbus (A 25; 93% vs. B 19; 79%, p = 0.232), back pain (A 20, 74% vs. B 20, 83%; p = 0.508), and inability to walk (A 15, 56% vs. B 16, 67%; p = 0.567). Involvement of ≥ 3 vertebrae was significantly more prevalent in group B (A 6, 23% vs. B 11, 46%; p = 0.09). The median time from symptom onset to diagnosis was longer in group B (A 13 weeks vs. B 21 weeks; p = 0.07).
Conclusions:
The pandemic had minimal effect on the clinical characteristics of TBS patients at presentation. However, most patients were in a serious condition at the time of presentation, suggesting that the symptoms had existed, but did not receive appropriate care from primary healthcare facilities. A meticulous assessment enabling early diagnosis and initiation of therapy is crucial.
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