Evaluation of the relationship between smear positivity and high-resolution CT findings in children with pulmonary tuberculosis.

BACKGROUND: The aim of this study is to find a relationship between the radiological manifestations of childhood tuberculosis on a high-resolution computed tomography (HRCT) and the results of sputum smear. This study aims to propose an alternative indicator of infectivity in terms of prevention of disease transmission through selective isolation policy in children whose clinical condition is highly suggestive of tuberculosis. MATERIAL/METHODS: This retrospective comparative study was performed on 95 children under 15 years of age diagnosed with tuberculosis based on both WHO criteria and positive sputum culture for mycobacterium Tuberculosis. The children were admitted for TB screening in the pediatric department of national research institute of tuberculosis and lung disease (NRITLD) between 2008-2012. Direct smear collected from sputum or gastric lavage, as well as HRCT were performed in all children prior to administration of medical therapy. Children were divided into 2 groups based on positive and negative smear results. HRCT abnormalities, as well as their anatomical distribution were compared between these 2 groups using multivariate analytic model. RESULTS: The most prevalent abnormalities in the positive smear group were consolidation, tree-in-bud pattern, upper lobe nodular infiltration and cavitation. The negative smear group featured lymphadenopathy, consolidation, collapse and nodular infiltration in the upper lobe. Cavity, tree- in-bud pattern and upper lobe nodular infiltration were highly associated with smear positivity in children. Conversely, lymphadenopathy and collapse had significant association with a negative smear. CONCLUSIONS: This study revealed that cavity, tree-in-bud and upper lobe nodular infiltration has significant association with smear positivity in childhood tuberculosis. On the other hand, lymphadenopathy and collapse were closely associated with smear negativity in this age group. It was also demonstrated that children with a positive smear most likely presented with radiological features of post primary tuberculosis, while the negative smear group most often manifested with primary tuberculosis.

Underlying Causes of Persistent and Recurrent Pneumonia in Children at a Pulmonary Referral Hospital in Tehran, Iran.

BACKGROUND: There is limited data on recurrent or persistent pneumonia in children, particularly in the developing world. This is a retrospective, cross-sectional study of children with recurrent or persistent pneumonia admitted to the Pediatric Department of Massih Daneshvari Hospital, Tehran, Iran. METHODS: Children under 18 years of age, who were admitted to the hospital with pneumonia between 2007 and 2013, were investigated to find out the prevalence of recurrent and persistent pneumonia and to recognize their underlying diseases. Descriptive statistics were calculated for all data. RESULTS: Out of 601 children admitted for pneumonia, 229 (38.1%) met the criteria for recurrent or persistent pneumonia. An underlying illness was identified in 194 patients (84.72%). The most common underlying causes of recurrent pneumonia included aspiration syndrome (51.75%), recurrent wheezing (20.17%), and congenital heart diseases (20.17%). The most common underlying illness of persistent pneumonia included pulmonary tuberculosis (38.75%), recurrent wheezing (28.75%), and aspiration syndrome (26.25%). CONCLUSIONS: The result showed that the majority of patients with recurrent or persistent pneumonia had an underlying illness. New strategies and guidelines are required for early diagnosis of underlying causes of recurrent or persistent pneumonia in children.

Features of Adolescents Tuberculosis at a Referral TB's Hospital in Tehran, Iran.

OBJECTIVE: To identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow-up of the diagnosed cases of active tuberculosis (TB) adolescents. METHODS: This study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Tehran, Iran, between March 2006 and March 2011. RESULTS: Of the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%. The most common presenting symptom was cough (86%). Isolated pulmonary TB (PTB) was detected in 113 patients (79%), 21 patients (14.7%) had extrapulmonary TB(EPTB), and 9 patients (6.3%) had PTB and EPTB. The most common site of EPTB was pleural (14%). The most common radiographic finding was infiltration (61%). Positive acid fast smears were seen in 67.6%. Positive cultures for Mycobacterium tuberculosis (M. TB) were seen in 44.7%. Positive Polymerase chain reaction (PCR) results were seen in 60%. The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001), smear positive (p=0.001), culture positive (p<0.001) and have positive PCR results (p=0.009). The type of TB (p=0.017) was a significant factor influencing loss to follow-up. CONCLUSIONS: The study has revealed that the clinical and radiological findings of TB in adolescents are combination as identified in children and adults. The TB control programs should pay more attention to prevention and treatment of TB in adolescents.