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Tuberculous pleural effusion in children
J M Merino1, I Carpintero, T Alvarez
1Pediatric Department, General Yagüe Hospital, Burgos, Spain.
Insights
Pediatric tuberculous pleural effusion occurs in 22.1% of primary pulmonary tuberculosis cases, often in older children. Short-course chemotherapy is effective for treating this condition.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Radiology
Background:
- Tuberculous pleural effusion is a significant manifestation of pediatric tuberculosis.
- Understanding its clinical, radiographic, and bacteriologic features is crucial for diagnosis and management.
Purpose of the Study:
- To detail the age distribution, clinical, laboratory, radiographic, and bacteriologic findings in pediatric patients diagnosed with tuberculous pleural effusion.
- To evaluate the effectiveness of antituberculous therapy.
Main Methods:
- Retrospective study of pediatric patients (<18 years) with primary pulmonary tuberculosis.
- Analysis of medical records for demographics, clinical, bacteriologic, and evolution data.
- Independent radiologist review of chest radiographs.
Main Results:
- Tuberculous pleural effusion was present in 22.1% of pediatric tuberculosis cases.
- Patients with pleural effusion were significantly older (mean age 13.5 years).
- Bacteriologic confirmation was achieved in 56.4% of cases, with high sensitivity for tuberculin testing (>5mm induration).
Conclusions:
- Pleural effusion represents a substantial proportion of pediatric tuberculosis cases, predominantly in adolescents.
- Parenchymal consolidation is the most frequent associated radiographic finding.
- Short-course antituberculous chemotherapy (6-9 months) demonstrated high efficacy and safety.
Study Objectives:
To describe the age distribution, clinical, laboratory, radiographic, and bacteriologic findings of pediatric patients with tuberculous pleural effusion.
Design:
A retrospective study.
Patients And Methods:
We have identified all cases of primary pulmonary tuberculosis in children < 18 years, reported to the health department. We have collected information from medical records regarding demographics, clinical findings, bacteriologic results, and evolution. Chest radiographs obtained at the time of initial evaluation were reviewed independently by two groups of radiologists who were blind to the clinical and epidemiologic data.
Results:
Between January 1983 and December 1996, 175 children < 18 years were diagnosed as having primary pulmonary tuberculosis. Among them, 39 patients (22.1%) showed pleural effusion on chest radiograph. The mean age of patients with tuberculous pleural effusion was significantly higher (13.52+/-0.5 years vs 6.97+/-0.42 years). The sensitivity of the tuberculin test is 97.4% for an induration > or = 5 mm. Pleural fluid analysis shows a lymphocytic exudative effusion. Chest radiograph review showed unilateral pleural effusion in all cases. Pleural effusion was the sole radiographic manifestation in 41% of cases. Parenchymal disease is associated in 23 cases (59%). Bacteriologic confirmation of tuberculosis was achieved in 22 cases (56.4%). Cultures of pleural fluid and biopsy material both yielded Mycobacterium tuberculosis in 15 of 34 (44.1%) and 12 of 18 (66.6%), respectively, for samples under study. Pleural biopsy specimens showed granulomatous inflammation in 18 of 23 cases (78.3%). Antituberculous therapy for 6 to 9 months was effective in all cases. Transient side effects occurred in 1 of 39 patients (2.9%).
Conclusions:
Pleural effusion accounts for 22.1% of cases of pediatric pulmonary tuberculosis. Parenchymal consolidation is the most common associated radiographic finding. Bacteriologic confirmation was achieved in 56.4% of cases. A short course of chemotherapy is effective.