Prevalence of tuberculosis in severe acute malnutrition: a prospective observational study

Abstract

Background Tuberculosis (TB) and severe acute malnutrition (SAM) are important causes of morbidity and mortality in children in the developing World. Malnutrition mainly affects cell mediated immunity (CMI) and CMI is the principal host defense against tuberculosis. Hence, there is possibility that children with SAM may have tuberculosis, and often it may be a hidden entity. Further, Children with SAM and TB are 40% more likely to die than children with SAM and without TB. Children with SAM rarely come to health care settings with complaint of under nutrition rather they present for some other illness. For these reasons, this study intends to seek for TB among children with SAM and look into the common presenting complaints. Methods All cases of SAM meeting the inclusion criteria were evaluated with mantoux, chest x-ray, gastric aspirate/sputum analysis and gene xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data was entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data. Result Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). 40% of TB cases were without any systemic complaints. Only 19.6% of cases presented with nutritional complaint. Conclusion This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (pulmonary TB) in every case of SAM irrespective of symptoms.