Clinical, Radiological and Inmunological Features in Children with Pulmonary Tuberculosis: A Review

Abstract

In the whole world, tuberculosis (TB) continues being an important health problem. It produces a great number of deaths in children, mainly in the wake of the HIV epidemic. In addition, the globalization with the increased of the international travels and the immigration makes that TB control be more difficult. This is a clinical, radiological and immunological review in children TB where we search to contribute the data in the literature. ContextTuberculosis (TB) is one of the most important global health problems. The latest estimates included in the Global tuberculosis report are that there were 8.6 million new TB cases in 2012 and 1.3 million TB deaths worldwide. Of those, 530.000 cases and 74.000 deaths were children [1]. Clinical and radiological findings, such as hemoptisis, cough, caverns or upper-lobe condensations, might be reliable and well established in adults. By contrast, these findings might be more difficult to evaluate in children due to more nonspecific symptoms and heterogeneus radiological findings [2]. ObjectiveThe present work overviews the most important clinical and radiological findings in children diagnosed with tuberculosis infection and disease. We included articles that reported cases with children from 2 months to 13 years. Children were from different backgrounds, and from developed and underdeveloped countries. Data SourcesThe selection of studies for analysis was as follows: all articles published from October 2008 to December 2013, which described clinical and radiological findings of children with TB were selected. These articles were obtained by searching throughout several international databases including Pubmed, Scopus, Highwire Press, Scientific Information Databases, Google Scholar and EBSCO-host.To locate the articles to include in our review, the strategy consisted of an exhaustive search including the following medical subject headings (MeSH) terms: "tuberculosis" or "pulmonary tuberculosis" in combination with "children" or "infant" or "infancy", in combination with "clinical symptoms", "radiological findings", "Mantoux", "tuberculosis diagnosis", "management of tuberculosis" and "tuberculosis treatment". Study SelectionInclusion criteria for systematic review were: 1) Retrospective or prospective cohort studies; 2) Reporting clinical, radiological or Mantoux results in TB patients 3) Studies including data at the national level; and 4) Studies on TB patients meeting either the WHO recommended definitions for "definite cases" or "other than definite cases" or TB patients meeting the possible, probable or confirmed case definition as published by the European Commission in 2008.Opinion articles, editorials, comments, case studies and/or drug efficacy tested in vitro or through clinical trials were excluded from the systematic review. Furthermore, those articles not published in English or Spanish language were excluded from the review. Literature searching was performed until 1 st December 2013. Using the search terms previously described above, fifty-three st...