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Tuberculosis in infants less than 3 months of age
H S Schaaf1, R P Gie, N Beyers
1Tygerberg Hospital, University of Stellenbosch, Department of Paediatrics and Child Health, Republic of South Africa.
Insights
Early diagnosis of infant tuberculosis is crucial. This study details clinical and radiological findings in infants under 3 months, aiding timely identification of this severe condition.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Tuberculosis in infants under 3 months is often fatal.
- Early diagnosis is critical but challenging.
- Understanding clinical and radiological features is key.
Purpose of the Study:
- To describe the clinical and radiological features of tuberculosis in infants younger than 3 months.
- To aid in the early diagnosis of this condition.
Main Methods:
- Retrospective analysis of 38 infants with culture-proven tuberculosis.
- Clinical data collection including symptoms, physical examination findings.
- Radiological assessment (chest radiography) and microbiological investigations (cultures from various samples).
Main Results:
- Common symptoms included cough (87%) and tachypnea (82%).
- Hepatomegaly (66%) and splenomegaly (53%) were frequent. Radiological findings included miliary tuberculosis (26%) and adenopathy (52%).
- Mycobacterium tuberculosis was detected in gastric aspirates (92%) and other samples; maternal tuberculosis was noted in 23%.
Conclusions:
- Clinical and radiological features can guide early diagnosis of infant tuberculosis.
- Respiratory symptoms, hepatosplenomegaly, and specific radiographic findings are important indicators.
- Microbiological confirmation from various sources, including gastric aspirates, is vital.
Abstract:
The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.