Cavitating pulmonary tuberculosis below age of 2 years
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1Department of Pediatrics, Goculdas Tejpal Hospital, Bombay.
Insights
Diagnosing childhood pulmonary tuberculosis in children under two is challenging. Key findings reveal varied radiological signs, frequent complications, and often absent typical tuberculosis indicators, leading to high mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Primary cavitary pulmonary tuberculosis in infants presents unique diagnostic challenges.
- Early childhood tuberculosis often occurs in severely malnourished children, with maternal disease as a potential source.
Purpose of the Study:
- To delineate the spectrum of primary cavitary pulmonary tuberculosis in hospitalized children under two years old.
- To identify diagnostic difficulties and clinical characteristics of this condition in young children.
Main Methods:
- Prospective study of 75 hospitalized children under two years with primary cavitary pulmonary tuberculosis.
- Diagnosis relied on clinical, radiological, tuberculin tests, and histopathology, not solely on tubercle bacilli isolation.
Main Results:
- Peak incidence in 7-12 month olds; 73% severely malnourished; fever and cough were primary symptoms.
- Radiological findings were diverse, often multiple and bilateral lesions; miliary nodules (45.3%) and tuberculous meningitis (28%) were common.
- Classic diagnostic signs like lymphadenopathy and positive tuberculin tests were frequently absent, complicating diagnosis.
Conclusions:
- Primary cavitary pulmonary tuberculosis in infants presents with atypical features, making diagnosis difficult.
- High mortality (34.7%) underscores the need for improved diagnostic strategies and timely intervention in this vulnerable population.
Abstract:
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].