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Childhood tuberculosis in a referral centre: clinical profile and risk factors
V Seth1, P K Singhal, O P Semwal
1Department of Pediatrics, Ail India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Pediatric tuberculosis in children is often linked to malnutrition. Younger children (<3 years) face higher risks of severe disease, especially without BCG vaccination or a positive family history.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Tuberculosis (TB) remains a significant health concern in pediatric populations.
- Malnutrition is prevalent among children with TB, impacting disease presentation and severity.
- Understanding risk factors and clinical manifestations is crucial for early diagnosis and management of childhood TB.
Purpose of the Study:
- To analyze the clinical profile and radiological findings of pediatric tuberculosis.
- To identify risk factors associated with the development and severity of childhood TB.
- To evaluate the association between family history, BCG vaccination, and Mantoux test results.
Main Methods:
- Retrospective analysis of 196 children diagnosed with TB at a Pediatric Tuberculosis Clinic.
- Data collection included patient demographics, nutritional status, BCG vaccination history, family history of TB, Mantoux test results, clinical symptoms, and radiological findings.
- Statistical analysis to determine associations between variables and disease severity.
Main Results:
- 61% of children were malnourished (Grades III and IV).
- A positive Mantoux test was observed in 77% of cases; 51.4% showed parenchymal lesions on chest X-ray.
- Younger children (<3 years) had a higher incidence of severe TB forms (e.g., military TB), associated with lack of BCG vaccination and negative family history/Mantoux test.
- Fever and cough were predominant symptoms in older children, while weight loss was more common in younger children.
Conclusions:
- Pulmonary primary complex was the most common diagnosis (82.1%), particularly in older children.
- Malnutrition, young age, lack of BCG vaccination, and negative family history/Mantoux test are significant risk factors for severe pediatric TB.
- Early diagnosis and intervention are critical, especially in high-risk pediatric groups.
Abstract:
One hundred and ninety six children (age group 6 months to 12 years) attending the Pediatric Tuberculosis Clinic at AIIMS, New Delhi, over a period from January 1988 to December 1989 were analysed. Nearly 61% of children were malnourished (Grades III and IV). A positive family history was noted in nearly one third (33.7%) of cases while 41.3% of children had received BCG. A positive Mantoux test was noted in 77% of cases. The most prominent lesion on radiology was parenchymal (51.4%). In nearly two third of cases, both Mantoux test and X-ray chest was positive. A family history of tuberculosis and BCG vaccination was significantly associated with positive Mantoux test (p < 0.01). Fever and cough in older children (> 6 years) while weight loss in younger children (< 3 years) were the predominant symptoms. Most of the cases (82.1%) had pulmonary primary complex, the proportion being higher in older age group. The severe form of tuberculosis, i.e., progressive primary disease, military tuberculosis, etc., were significantly more in younger children. The various risk factors significantly associated with severe form of tuberculosis were very young children (< 3 years), no BCG vaccination, a negative family history and a negative Mantoux test.