Pediyatrik akciğer dışı tüberküloz olgularının değerlendirilmesi: tek merkez deneyimi

Abstract

Aim: Extrapulmonary tuberculosis is observed more frequently and leads to complications with a higher rate in children compared with adults because the risk of lymphohematogen spread is higher. In this study, the clinical, laboratory, and radiologic findings and treatment outcomes were evaluated in pediatric patients who were followed up in our clinic with a diagnosis of extrapulmonary tuberculosis. Material and Methods: Seventy patients aged 0–18 years who were followed up with a diagnosis of extrapulmonary tuberculosis between 2008 and 2017 in the Division of Pediatric Infectious Diseases in our hospital were examined retrospectively. Results: The median age of the patients was 8,8 (range, 0,4–17) years and 47.1% were female (n=33). Twenty-seven patients (38.6%) were aged 0–4 years, 15 (21.4%) were aged 5–9 years, and 28 patients (40%) were aged 10–18 years. Forty-four patients (62.9%) were diagnosed as having extrapulmonary tuberculosis and 26 (37.1%) had pulmonary + extrapulmonary tuberculosis. The most common form of extrapulmonary tuberculosis was extrathoracic lymphadenopathy, which was found in 22 patients (31.4%). The other patients were diagnosed as having musculoskeletal system tuberculosis (n=10, 14.3%), gastrointestinal system tuberculosis (n=9, 12.9%), miliary tuberculosis (n=8, 11.4%), intrathoracic lymphadenopathy (n=7, 10%), renal tuberculosis (n=6, 8.6%), central nervous system tuberculosis (n=5, 7.1%), and pleural tuberculosis (n=3, 4.3%). Among a total of 58 patients in whom tuberculin skin test and interferon gamma release tests were studied together, tuberculin skin test positivity (n=37, 63.8%) was found with a higher rate compared with interferon gamma release test positivity (n=32, 55.2%), but the difference was not statistically significant (p=0.35). The median treatment period was 12 (range, 6–24) months. Among the patients whose treatments were terminated, improvement was observed in 52 patients (74.2%) and the development of sequela was observed in six patients (8.5%). Two patients who were diagnosed as having central nervous system tuberculosis (2.8%) died. Conclusion: Clinical, laboratory, and radiologic data should be evaluated together when making a diagnosis of extrapulmonary tuberculosis in children. Interferon gamma release tests alone are not superior to tuberculin skin test, but should be considered to be used in combination in the diagnosis.

Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

“…We analysed the multimorbidity patterns and how they were distributed according to social demographics (sex and age) and clinical variables (multimorbidity status and number of chronic diseases). The inpatients were divided into three groups according to growth stage: 0–4 years age group (infant to toddler age), 5–9 years age group (preschool age and early school age), 10–18 years age group (adolescence) 20 . 21 …”

Pancytopenia without hepatosplenomegaly: A rare manifestation of extrapulmonary tuberculosis in an adolescent boy

“…Extrapulmonary tuberculosis (EP-TB) is a well-recognized cause of pyrexia of unknown origin. [ 1 2 ] Risk of lympho-hematogenous spread is higher in young children, making them more vulnerable for EP-TB. In children, often the symptoms and signs of EP-TB are nonspecific and isolation of tubercular bacilli is difficult due to paucibacillary disease lowering the sensitivity of diagnostic tests, but delay in initiating antitubercular therapy (ATT) can lead to morbidity and mortality.…”

“…In children, often the symptoms and signs of EP-TB are nonspecific and isolation of tubercular bacilli is difficult due to paucibacillary disease lowering the sensitivity of diagnostic tests, but delay in initiating antitubercular therapy (ATT) can lead to morbidity and mortality. [ 2 ] Thus, it is recommended to initiate ATT empirically early in suspected EP-TB cases, when clinical and/or radiologic findings are compatible, and the symptoms cannot be explained by any other definitive etiology, even when it is not possible to isolate the tubercular bacilli by acid-fast bacilli (AFB) staining or nucleic acid amplification test. [ 2 ]…”

“…[ 2 ] Thus, it is recommended to initiate ATT empirically early in suspected EP-TB cases, when clinical and/or radiologic findings are compatible, and the symptoms cannot be explained by any other definitive etiology, even when it is not possible to isolate the tubercular bacilli by acid-fast bacilli (AFB) staining or nucleic acid amplification test. [ 2 ]…”

“…Lymph node, gastrointestinal system, central nervous system, and osteoarticular system are commonly affected by EP-TB. [ 2 ] However, the clinical presentation of TB in children with isolated hematological abnormalities is extremely rare. [ 1 ] Anemia, usually normocytic, normochromic, leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, and monocytosis are more common complications of TB rather than pancytopenia.…”