Abstract
Background: Tuberculosis has the dubious distinction of being the most persistent scourge of humankind. Childhood tuberculosis remains an important cause of morbidity and mortality in the developing countries despite the advances in diagnostic tests .TB in children is difficult to confirm and remains under diagnosed due to lack of specific diagnostic tools and most of the children present with non-specific signs and symptoms which are overlooked. The present study was planned to study the clinical profile and diagnosis of Pediatric Tuberculosis in a tertiary care teaching institute of Northern India.
Aims and Objectives: To study the clinico-epidemiological profile of Tuberculosis in children aged 3 months to 18 years.
Methods: This was a prospective cross sectional study conducted in a tertiary care teaching institute of Northern India over a period of one year. After approval from IEC and obtaining consent from parents, presumptive TB cases in the age group of 3 months to 18 years who met the inclusion criteria were recruited, additional investigations like chest X-ray, Mantoux test were ordered and CBNAAT, MGIT culture were done to confirm the diagnosis. Data collected in study tool was transferred into MS excel sheet for further processing and analysis by SPSS version 22.
Results: Out of 128 presumptive TB subjects, 46 had extra pulmonary TB and 30 had pulmonary TB. 47.36% were male with a male: female ratio of 0.9:1, with majority (76.32%) in the age group 11-18 years. The commonest presenting symptoms were fever (71.05%) followed by cough (61.84%) and weight loss (39.47%). Family history of contact could only be obtained in 20 patients (26.31%). Pallor was the most common sign observed in 32(42.10%). All the subjects had received BCG vaccine and most of the subjects 58(76.3%) belonged to middle socio economic group.
Conclusion: Childhood Tuberculosis presents with non-specific signs and symptoms in the pediatric age group and diagnosis of childhood tuberculosis requires a detailed history, good clinical examination and thorough investigative workup as well.
Keywords: Tuberculosis, Childhood, Mantoux, CBNAAT.
References
- Narain JP. Tuberculosis – epidemiology and control. World Health Organization, Regional Office for South East Asia, New Delhi, India, 2002; SEA/TB/2002.248:15-18.
- GlobalTuberculosisReport2016, WHO Report 2014. http://www.who.int/tb/publications/global_report/2017/en/index.html.accessed 31 October, 2017.
- Radhakrishna S, Frieden TR, Subramani R, Kumaran PP. Trends in the prevalence and incidence of tuberculosis in south India. Int J Tuberc Lung Dis 2001;5:142-57.
- Donald PR. Children and tuberculosis: protecting the next generation. Lancet 1999;353:1001-02.
- World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulm-onary TB in adults and children: policy update. Geneva, Switzerland: WHO, 2013.
- Sager P, Schalimtzek M, Moller-Christensen V. A case of spondylitis tuberculosa in the Danish Neolithic Age. Dan Med Bull 1972;19:176-80.
- Global Tuberculosis Report 2016, WHO Report 2014http://www.who.int/tb/publications/global_report/2017/en/index.html.accessed 31 October, 2017).
- National Guidelines on diagnosis and treatment of Pediatric Tuberculosis 2017, https://tbcindia.gov.in/showfile.php?lid=2904 page 8-15.
- Guidance document for use of Catridge Based-Nucleic Acid Amplification Test (CB-NAAT) under Revised National TB Control Programme (RNTCP) issued central TB division, directorate general of health services september 2013.
- Global laboratory initiative advancing TB diagnosis mycobacteriology laboratory manual April 2014. http://www.who.int/tb/laboratory/mycobacteriology-laboratory-manual.pdf accessed august 2017.
- Franco R, Santana M. Clinical and Radiological Analysis of Children and Adolescents With Tuberculosis in Bahia, Brazil .The Brazilian Journal of Infectious Diseases 2003;7:73-81.
- Sivanandan S, Walia M, Lodha R, Kabra SK. Factors Associated with Treatment Failure in Childhood Tuberculosis. Indian Pediatr 2008;45:769-71.
- Kakarani VA, Pratinidhi AK. A study of childhood tuberculosis. Ind J Tub 1992;39:177-80.
- Bai SS, Devi RL. Clinical spectrum of tuberculosis in BCG vaccinated children. Indian Pediatr2002;39:458-62.
- Garg P. Childhood tuberculosis in a community hospital from a region of high environmental exposure in north India. Journal of clinical and diagnostic research 2008:2:634-38.
- Wu XR, Yin QQ, Jiao AX, Xu BP, Sun L, Jiao WW, et al. Pediatric Tuberculosis at Beijing Children’s Hospital:2002-2010. Pediatrics;2012:130.
- de Pontual L, Balu L, Ovetchkine P, Maury-Tisseron B, Lachassinne E, Cruaud P, et al. Tuberculosis in adolescents: a French retrospective study of 52 cases. Pediatr Infect Dis J 2006;25:930-32.
- Sivanandan S, Walia M, Lodha R, Kabra SK. Factors Associated with Treatment Failure in Childhood Tuberculosis. Indian Pediatr 2008;45:769-71.
- Marais B J, Gie RP, Hesseling AC. A refined symptom based approach to diagnose pulmonary tuberculosis in children. Pediatrics 2006; 118: e1350-59.
Corresponding Author
Dr Ashok Garg
Address: House No.-35, Ward no.-2, Village-Anu Kalan, P.O. & Distt.- Hamirpur (H.P.), India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.