767. A 7-Year Retrospective Study of Pediatric Tuberculosis in a Third-Level Hospital in Mexico City

Abstract

BackgroundAccording to WHO data, in 2016 10.4 million people were infected with tuberculosis (TB), from which one million were patients ≤18 years, and 250,000 deaths. The diagnosis of TB in pediatric patients is a challenge given the clinical behavior.MethodsThis is a retrospective, descriptive, and observational study of patients under 18 years treated at the TB Clinic at Department of Pediatric Infectious Diseases in the National Institute of Pediatrics (INP) in Mexico City during the period 2011–2018.ResultsA total of 118 cases were included; 64 (54.5%) were male, and the average age at diagnosis was 79.45 ± 63.7 months. The most frequent presentations were; lymph node in 50 (42.4%) cases, followed by skeletal 20 (16.9%), pulmonary 16 (13.6%), meningeal 11 (9.3%), abdominal 6 (5.1%), cutaneous 6 (5.1%), and miliary 4 (3.1%). The most common symptoms were fever (52%) and lymphadenopathy (49%). TST was applied in 42 cases (55% positive). A positive COMBE was reported in 47.5% of patients. We performed: GeneXpertâ in 33 (28%) cases with 36% positive results; biopsy in 74 (62%) cases with 92% positive cases; and Ziehl-Neelsen stain in 30 (25.4%) cases with 26% positive results. Positive cultures (41%) isolated: M. bovis 25 (52.4%), followed by MTB complex in 9 (19%), M. tuberculosis 7 (14.3%) and atypical Mycobacteria with 7 (14.3%) cases. The most frequent treatment was: INH (98.2%), RIF (95.5%), E (85.6%) and PZA (77.5%) with an average of 6.3 months during intensive phase and 10.1 months of maintenance. Primary immunodeficiency (PID) was detected in 33 (20.3%) cases, mainly: chronic granulomatous disease in 15 (45.5%), Mendelian susceptibility to Mycobacterial diseases was found in 8 (24.2%) and severe combined immunodeficiency in 7 (21.2%). Overall mortality was 2.5%.ConclusionTuberculosis in Mexico is still a major public health problem and thus is important to remain suspicious of it. This is the first report in Mexico where immunodeficiency is investigated in pediatric patients with tuberculosis, detected in one out of five cases, which stresses the need of its search, given this can modify the outcome.Disclosures All authors: No reported disclosures.