Cavitating pulmonary tuberculosis below age of 2 years

A prospective study was conducted on 75 consecutive cases of primary cavitary pulmonary tuberculosis in hospitalized children below 2 years to determine the spectrum of the disease. Diagnosis was based on clinical, radiological, tuberculin test and histopathological findings and not on isolation of tubercle bacilli. Peak age was 7-12 months. Ten mothers suffered from pulmonary fibrocavitary disease and 73% of cases were severely malnourished. Presenting symptoms were fever and cough, at times dyspnea and often followed measles. Unlike adults, hemoptysis was seldom encountered. Cavitary lesions were characterized by protean radiological manifestations and varied in size and appearance. They were more often multiple than solitary, bilateral or distributed in one or more lobes, usually in the right lung. Location within consolidation and other associated pulmonary pathology was frequent with miliary nodules in 45.3%. Widespread hematogenous infection was common with tuberculous meningitis in 28%. The accepted diagnostic features of tuberculosis, viz., hilar and mediastinal lymhadenopathy and positive tuberculin test were often absent. Mortality was 34.7% and in inverse proportion to age. The observations stress the difficulties in diagnosis [corrected].