Treatment of Tuberculosis in Children

Lorin, Martin I.; Hsu, Katharine H. K.; Jacob, Susan C.

doi:10.1016/s0031-3955(16)34361-9

Cited by 36 publications

(5 citation statements)

References 19 publications

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“…13,22 Enhanced resolution of the basal exudate and improved survival rate were shown to be associated with the use of corticosteroids in TBM. 23 Early ventriculoperitoneal shunting in children with significant hydrocephalus has been shown to reduce morbidity and mortality, and is a potentially favorable predictor of good outcome.…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System Tuberculosis in Children: A Review of 214 Cases

et al. 1998

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ABSTRACT. Objective. To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey.Study Design. Results. Of the 214 patients with tuberculous meningitis, 112 (52%) were male. The mean age at presentation was 4.1 years, with 165 patients (77%) younger than 5 years. Twenty-two patients (10%) were in the first stage of the disease, 120 (56%) in the second, and 72 (34%) in the third. Our epidemiologic data showed that 141 (66%) of the patients had a family history of TB, and 64 (30%) had a Mantoux skin test result of >10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 187 patients (87%) (hilar adenopathy, 33%; infiltrates, 33%; miliary pattern, 20%; and pleural effusions, 1%, and 172 (80%) cases with hydrocephalus, 26% with parenchymal disease, 15% with basilar meningitis, and 2% with tuberculomas. Only 22 (13%) of 164 children had a positive acid-fast bacilli smear in cerebrospinal fluid, and Mycobacterium tuberculosis was isolated in 49 patients (30%). All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 2 months, followed by 10 months of Isoniazid and rifampin alone. Also, all the patients received adjuvant treatment with steroids early in the course of treatment, and 140 of 172 cases with hydrocephalus had surgical intervention. The overall mortality rate was 23%.Conclusion. One or more of these findings: a family history of TB, positive tuberculin skin test results, abnormal cranial computed tomography, and/or cerebrospinal fluid analysis compatible with TBM were found in all but 3 children in our study. Pediatrics 1998;102(5). URL: http://www.pediatrics.org/cgi/content/full/102/5/e49; central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.

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Section: Discussionmentioning

confidence: 99%

Central Nervous System Tuberculosis in Children: A Review of 214 Cases

et al. 1998

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“…Outcome is influenced by many factors such as the severity of the disease at the start of treatment, the effectiveness of antituberculous drugs, the management of neurological complications, and appropriate supportive measures 14,15 . Several studies demonstrated that early diagnosis and treatment in the first stage of the disease is associated with almost complete recovery without sequelae, while the morbidity and mortality in those patients in whom the diagnosis was made and treatment started in the second or third stage were proportional to the severity of the disease 3,16,17 .…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Meningitis: A Clinical and Laboratory Study of 20 Patients in Qatar

Alsoub

1998

Int J Clinical Practice

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SUMMARYTwenty cases of tuberculous meningitis were diagnosed at the Hamad Medical Corporation between 1990 and 1995. Most of the patients (90%) were expatriates. The most common presenting features were fever, headache, neck stiffness and altered mental status. Five patients were in stage 1 disease at the time of presentation, 11 in stage 2, and four in stage 3. Examination of cerebrospinal fluid showed at least one abnormal finding in all patients, and culture grew Mycobacterium tuberculosis in 50%. A positive tuberculin skin test in 50% of patients, abnormal chest X‐ray in 35%, abnormal CT scan or MRI showing tuberculoma or hydrocephalus in 55%, and positive sputum culture for M. tuberculosis in 15% helped establish the diagnosis. All the patients were treated with antituberculous drugs and steroids. Seventeen (85%) survived, three with severe neurological sequelae; three (15%) died. Poor outcome was associated with advanced stage of disease at presentation and high CSF protein. Tuberculous meningitis continues to be an important disease in Qatar, especially in expatriates, and should be considered in the differential diagnosis in any patient presenting with fever and change in sensorium.

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“…Two previous studies from our group have demonstrated the particularly high frequency of occult rickets and the decrease of vitamin D metabolites under INH and RIF treatment in children with TBC [20,21]. One of the most important challenges in the treatment of TBC is the compliance of either the child or the parents [7,17]. Our home care facility was specifically designed for the care of tuberculous children in their family setting and was a valuable tool for epidemiological and clinical studies.…”

Section: Discussionmentioning

confidence: 99%

“…600 rag) were given for a minimum of 9 months for mediastinal lymphadenopathy, erythema nodosum, in association with ethambutol 20-25 mg/kg for 2 months in the initial phase for pulmonary TBC, miliary TBC and meningitis. Corticosteroids were used in all patients with meningitis, miliary TBC, pleural effusion, and bronchial obstruction [7,16]. Some of these children did not receive corticosteroids in order to compare a group of 15 patients with steroids and a group of 14 patients without steroids in the management of bronchial obstruction.…”

Section: Treatment and Outpatient Carementioning

confidence: 99%

Tuberculosis in children: a 13-year follow up of 1714 patients in a Belgian home care centre

et al. 1991

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From May 1970 to September 1983, 1714 children with different forms of primary tuberculosis were referred to the paediatric home care centre (Enfants soignés au Foyer, E.S.F.) of the Brussels University Hospital St.-Pierre. They were subdivided in five groups: asymptomatic (33%), symptomatic (28%), dubious tuberculous infections (35%), high-risk contacts (3%) and unestablished diagnosis (1%). They were aged from 10 days to 19 years, and 82% of them were migrants of low socio-economic level. Fifty percent of the symptomatic infections, mainly pulmonary, appeared in children under 3 years of age. An adult source of contamination was identified in 33% of the cases (48% of the symptomatic children). Diagnosis was based on tuberculin screening with a 2IU intradermal test. Gastric aspirates yielded Mycobacterium tuberculosis in 15% of our patients, 11% of them showing resistance to one or more tuberculostatic drugs. Treatment was given to 1359 patients with excellent results. Therapy was shortened during the last 2 years of the study from 12 to 6 months for the asymptomatic patients and from 12 to 9 months for the symptomatic infections. Few complications were observed. Tuberculosis remains a serious cause of morbidity particularly in migrant children. Correct diagnosis and treatment of the disease is very important.

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Treatment of Tuberculosis in Children

Cited by 36 publications

References 19 publications

Central Nervous System Tuberculosis in Children: A Review of 214 Cases

Central Nervous System Tuberculosis in Children: A Review of 214 Cases

Tuberculous Meningitis: A Clinical and Laboratory Study of 20 Patients in Qatar

Tuberculosis in children: a 13-year follow up of 1714 patients in a Belgian home care centre

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