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Computed tomography with normal chest radiograph in tuberculous infection
C Delacourt1, T M Mani, V Bonnerot
1Department of Paediatric Pneumonology, Hôpital des Enfants Malades, Paris, France.
Insights
Identifying children with tuberculosis infection is crucial for prevention. Many infected children have enlarged lymph nodes, indicating unrecognised active disease, suggesting a two-drug treatment may be better than isoniazid alone.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Primary tuberculosis infection in children requires preventive treatment to reduce disease incidence.
- Diagnosing tuberculosis infection without active disease is challenging, as minimal active disease may be missed on chest X-rays.
- Mediastinal lymph node enlargement is a potential indicator of active tuberculosis in infected children.
Purpose of the Study:
- To evaluate the utility of computed tomography (CT) in detecting unrecognised active tuberculosis in children with primary infection and normal chest radiographs.
- To assess the size of mediastinal lymph nodes in infected children compared to controls.
- To inform treatment strategies for pediatric tuberculosis infection.
Main Methods:
- Computed tomography (CT) scans were performed on 15 children with confirmed tuberculous infection and normal chest radiographs.
- Mediastinal lymph node sizes were measured in infected children and compared to 10 tuberculosis-free control children.
- Age-related differences in lymphadenopathy were analyzed.
Main Results:
- Sixty percent (9 of 15) of infected children exhibited enlarged mediastinal lymph nodes on CT scans.
- Enlarged lymph nodes were more prevalent in infected children under 4 years old compared to those over 8 years old.
- The findings suggest a significant rate of unrecognised active disease in children with primary tuberculosis infection.
Conclusions:
- CT imaging can reveal unrecognised active tuberculosis in children with primary infection and normal chest X-rays.
- The presence of enlarged lymph nodes in infected children challenges the assumption of latent infection and suggests active disease.
- A two-drug regimen may be more effective than isoniazid monotherapy for treating these cases of unrecognised active tuberculosis.
Abstract:
Children with primary tuberculosis infection without disease must be identified and treated preventively to avoid an increase in the incidence of tuberculosis in children. However, the recognition of infected cases without disease is often difficult. In particular, minimal active disease may be present in many cases but unrecognised on chest radiography. Computed tomography was therefore performed in 15 children with tuberculous infection and a normal chest radiograph to measure the size of their mediastinal lymph nodes. Ten control children without tuberculosis were also evaluated. When compared with controls it was found that nine of 15 (60%) infected children had enlarged lymph nodes. Adenopathies were more frequent in infected children less than 4 years old than in those over 8 years old. The demonstration of unrecognised active disease in many infected children raises the question of the adequate treatment for these children. It is proposed that a two drug regimen would be more appropriate than isoniazid alone in these cases.