Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children

Abstract

Background: Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan. Methods: In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years. Results: A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB. Conclusions: This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.

Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now

“…EPTB denotes TB involving organs except for the pulmonary tree [ 153 ]. The incidence of EPTB is higher in children than adults [ 154 , 155 ]. As EPTB affects various organs, clinical manifestations are vast and non-specific, making diagnosis difficult [ 156 ].…”

Better understanding extrapulmonary tuberculosis: A scoping review of public health impact in Pakistan, Afghanistan, India, and Bangladesh

“…20 The treatment success rates in this study were also similar to those of the previous study as the TBM success rate was low compared to other forms of EPTB. 20 21 TBM is the most severe form of EPTB and can be 100% fatal if left untreated. [21][22][23] The most common symptom of TBM in Pakistan was found to be fever followed by other symptoms such as headache, neck stiffness, seizures, vomiting, altered consciousness, and a few even reported cranial nerve lesions in some patients.…”

“…20 21 TBM is the most severe form of EPTB and can be 100% fatal if left untreated. [21][22][23] The most common symptom of TBM in Pakistan was found to be fever followed by other symptoms such as headache, neck stiffness, seizures, vomiting, altered consciousness, and a few even reported cranial nerve lesions in some patients. [22][23][24] The association of gender as a risk factor for TBM in Pakistan is uncertain, 23,24 and another study stated that female gender had a higher risk of developing TBM.…”

“…56 The most common forms of EPTB reported in Pakistan, were pleural TB, followed by LNTB, abdominal TB, osteoarticular, CNS, site not-specified, and miliary TB. [19][20][21][22][23][24][25][26][27][28] The LNTB form of EPTB is more common in India. Amongst the clinical manifestations of EPTB in India, body organs affected other than the lungs mainly include; lymphatics, pleural cavity, spinal, and genitourinary.…”

Extrapulmonary tuberculosis among children: peculiarities of age’s groups and drug resistance of mycobacterium tuberculosis

“…Клінічна картина ТБ у дитячому віці відрізняється від такої у дорослому віці: ризик розвитку хвороби після інфікування у дітей вищий, а період латентностікоротший, більша ймовірність розвитку позалегеневого ТБ (ПТБ) і тяжкого перебігу хвороби, клінічні та рентгенологічні вияви неоднорідні та часто неспецифічні, забір зразків для мікробіологічного дослідження технологічно складніший, хвороба часто має олігобактеріальний мікробіологічний профіль [15]. Зазначені особливості зумовлюють специфічні перешкоди для виявлення і діагностики позалегеневого ураження, що призводить до зменшення показника ефективного лікування [8]. Частота ПТБ може становити 15-20 % від усіх випадків ТБ, а результати візуалізації незавжди є специфічними і можуть імітувати багато захворювань, що свідчить про потребу комплексного підходу до диференційної діагностики, особливо у групах ризику [5,9].…”