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Risk of pulmonary tuberculosis in children with congenital heart disease
P L van der Merwe1, N Kalis, H S Schaaf
1Department of Pediatrics, University of Stellenbosch, Tygerberg Hospital, Republic of South Africa.
Insights
Children with congenital heart disease have a 2.5-fold higher risk of pulmonary tuberculosis. Certain heart conditions, like high-flow lesions and pulmonary stenosis, increase susceptibility, impacting treatment timelines.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Congenital heart disease (CHD) in children is associated with various health complications.
- Previous reports suggest a link between low-flow congenital heart lesions and increased pulmonary tuberculosis (TB) incidence.
- Understanding TB susceptibility in pediatric CHD patients is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the incidence of pulmonary tuberculosis in children with congenital heart disease.
- To determine if specific congenital heart conditions confer higher susceptibility to pulmonary tuberculosis.
- To assess the impact of pulmonary tuberculosis on the timing of cardiac surgery in pediatric patients.
Main Methods:
- Retrospective study analyzing data over a 6-year period.
- Comparison of pulmonary tuberculosis incidence in children with CHD versus healthy children.
- Categorization of CHD into low-flow and high-flow lesions, and acyanotic/cyanotic types for susceptibility analysis.
Main Results:
- Pulmonary tuberculosis was 2.5 times more common in children with CHD compared to controls.
- Children with congenital pulmonary stenosis and high-flow lesions (acyanotic and cyanotic) showed increased TB prevalence.
- No TB cases were observed in children with low-flow cyanotic lesions (e.g., tetralogy of Fallot).
- Pulmonary tuberculosis led to postponed cardiac surgery in 7.2% of all required cases.
- Sixty percent of CHD patients with pulmonary tuberculosis experienced delays in cardiac surgery due to the need for antituberculosis therapy.
Conclusions:
- Children with congenital heart disease exhibit a significantly higher incidence of pulmonary tuberculosis.
- High-flow acyanotic/cyanotic lesions and pulmonary stenosis are associated with increased TB susceptibility.
- Physicians should maintain a high index of suspicion for pulmonary tuberculosis in pediatric CHD patients, particularly those with specific high-risk lesions.
Abstract:
Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with certain heart conditions are more susceptible to pulmonary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal children from the same community. Children with congenital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great arteries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with congenital heart lesions should maintain a high index of suspicion for the development of pulmonary tuberculosis, especially in those with acyanotic and cyanotic high-flow lesions and pulmonary stenosis.