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Pulmonary tuberculous: Symptoms, diagnosis and treatment. 19-year experience in a third level pediatric hospital.
González Saldaña, Napoleón; Macías Parra, Mercedes; Hernández Porras, Marte; Gutiérrez Castrellón, Pedro; Gómez Toscano, Valeria; Juárez Olguin, Hugo.
Afiliação
  • Juárez Olguin H; Laboratorio de Farmacología, INP, Facultad de Medicina, Universidad Nacional Autónoma de México, Av Imán #1, 3er piso, Col Cuicuilco, CP 04530 Mexico City, Mexico. juarezol@yahoo.com.
BMC Infect Dis ; 14: 401, 2014 Jul 19.
Article em En | MEDLINE | ID: mdl-25037701
ABSTRACT

BACKGROUND:

Pulmonary tuberculosis (PTB) is an infectious disease that involves the lungs and can be lethal in many cases. Tuberculosis (TB) in children represents 5 to 20% of the total TB cases. However, there are few updated information on pediatric TB, reason why the objective of the present study is to know the real situation of PTB in the population of children in terms of its diagnosis and treatment in a third level pediatric hospital.

METHODS:

A retrospective study based on a revision of clinical files of patients less than 18 years old diagnosed with PTB from January 1994 to January 2013 at Instituto Nacional de Pediatria, Mexico City was carried out. A probable diagnosis was based on 3 or more of the following two or more weeks of cough, fever, tuberculin purified protein derivative (PPD) +, previous TB exposure, suggestive chest X-ray, and favorable response to treatment. Definitive diagnosis was based on positive acid-fast bacilli (AFB) or culture.

RESULTS:

In the 19-year period of revision, 87 children were diagnosed with PTB; 57 (65.5%) had bacteriologic confirmation with ZN staining or culture positive (in fact, 22 were ZN and culture positive), and 30 (34.5%) had a probable diagnosis; 14(16.1%) were diagnosed with concomitant disease, while 69/81 were immunized. Median evolution time was 21 days (5-150). Fever was found in 94.3%, cough in 77%, and weight loss in 55.2%. History of contact with TB was established in 41.9%. Chest X-ray showed consolidation in 48.3% and mediastinal lymph node in 47.1%. PPD was positive in 59.2%, while positive AFB was found in 51.7% cases. Culture was positive in 24/79 patients (30.4%), PCR in 20/27 (74.1%). 39 (44.8%) patients were treated with rifampin, isoniazid, and pyrazinamide while 6 (6.9%) received the former drugs plus streptomycin and 42 (48.3%) the former plus ethambutol. There were three deaths.

CONCLUSIONS:

PTB in pediatric population represents a diagnostic challenge for the fact that clinical manifestations are unspecific and the diagnosis is not confirmed in all cases; that is why clinical suspicion, X-ray findings and PPD are indispensable for opportune start of treatment.
Assuntos

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Tuberculose Pulmonar / Hospitais Pediátricos / Antituberculosos Tipo de estudo: Diagnostic_studies / Observational_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Mexico Idioma: En Revista: BMC Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Tuberculose Pulmonar / Hospitais Pediátricos / Antituberculosos Tipo de estudo: Diagnostic_studies / Observational_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Mexico Idioma: En Revista: BMC Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2014 Tipo de documento: Article