Tuberculose Em Pacientes Pediátricos: Como Tem Sido Feito O Diagnóstico?

Abstract

Objective: To describe clinical, radiological, epidemiological, and microbiological characteristics of pediatric patients with diagnosis of tuberculosis in a period of 15 years.Methods: Retrospective study including children and adolescents younger than 18 years diagnosed with tuberculosis in the Clinical Hospital of the Universidade Estadual de Campinas in São Paulo State, Brazil. Active tuberculosis was defined by the identification of Mycobacterium tuberculosis in culture, microscopy, or histopathological examination. Children with positive clinical history and radiological tests who had been exposed to sick adults or with positive tuberculin skin test were also considered as having active tuberculosis. Statistical analysis compared the data obtained from children younger and older than 10 years of age, since they present a disease pattern more similar to adults.Results: There were 145 identified cases, 61.4% in patients under 10 years of age. The main symptoms reported were coughing (55.9%) and fever (46.9%), and the variables of fever, coughing, weight-loss, and pain were significantly influenced by age, with a higher frequency in older children. Diagnosis was confirmed by culture, microscopy, or histopathology in 67.6% of the cases. The other cases (32.4%) had the diagnosis of tuberculosis based on clinical, radiological, and epidemiological characteristics, as well as tuberculin skin test. The positivity for culture, microscopy, and tuberculin skin test was, respectively, 65.8, 35.7, and 72.3%. History of contact with a sick adult was confirmed in 37.2%, without influence of age.Conclusions: Diagnosis of tuberculosis in children is still a challenge, since all the confirmation tests have low positivity. These results demonstrate the need for new diagnostic methods and improved strategies for searching sick contacts.

Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil.

“…Our ndings follow the results from the study by Cano et al [3]; those researchers identi ed an adult with TB in 37.2% of the cases of children diagnosed with TB. Gathering an accurate and current medical and social history of the person with TB allows the identi cation of household contacts.…”

“…The main challenge related to childhood TB is the diagnosis, which is made di cult by the absence of a test that can be considered the gold standard. However, the con rmation of the disease in the pediatric age group is often a sentinel event that signals the presence of an adult with TB in the child's household [3].…”

“…The diagnostic techniques classically used in adults have low sensitivity and speci city when used for children, and con rmation by bacteriological identi cation is not always possible. In addition, many times treatment has been carried out without isolation of mycobacteria, based on a triad referring to the clinical and radiological picture, positivity of the tuberculin test, and contact with an adult with bacilliferous TB [3].…”

Characterization of tuberculosis in children and adolescents in underdeveloped country

“…The literature demonstrates that although mycobacteria research and culture are the most commonly used diagnostic methods when TB is suspected, less than 20% of the children with the diagnosis have a positive bacilloscopy and the culture detects M. tuberculosis in less than 50% of the cases. 8 This is most often due to the characteristics of pulmonary lesions in this age group, noncavitary, with a small number of bacilli and/or because of the technical difficulty in obtaining sputum, since children up to school age can not expectorate. 5 However, in the present study, it was possible to show that TB cases presented a high number of positive results in the first (66.6%) and second (63.8%) smear microscopies, but the higher rates of smear positivity suggest a selection bias for older children (58.2% are 11 to 14years old) who are more likely to provide a sputum sample with higher bacillary load, 9 it is also worth noting that adolescents express a disease with a pattern more similar to that of an adult.…”

Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil

“…The main challenge related to childhood TB is the diagnosis, which is made difficult by the absence of a test that can be considered the gold standard. However, the confirmation of the disease in the pediatric age group is often a sentinel event that signals the presence of an adult with TB in the child's household [3].…”