Clinical Profile of Pediatric Tuberculosis, Presenting to the Emergency Department of Tertiary Care Hospital in Karachi, Pakistan.

Abstract

Abstract Background Tuberculosis (TB), a preventable airborne infectious disease, early detection is essential to improve health outcomes. Extent of childhood tuberculosis is unknown and is estimated to be around 6% of all incidences. Diagnosis of pediatric tuberculosis is always difficult and no age is spared, however, children <5 years are more at risk. Children frequently admitted through emergencies of hospitals with different working diagnoses and later diagnosed as tuberculous. Despite multiple studies from Pakistan; the complex and multifaceted ED presentation of childhood tuberculosis was not looked in. Primary objective was to assess the clinical profile of tuberculosis patients presenting to ED, the secondary objective was to evaluate the relation of BCG vaccination, history of contact, and measles. Methods This was a retrospective chart review of children admitted to the study center with the discharge diagnosis of Childhood Tuberculosis from June 2010 to June 2015 as per WHO criteria. Patient demographic characters, medical history, and physical examination findings in ED along with vital signs and laboratory variables will be recorded from the charts. CXR, CBC, ESR, sputum analysis, and lab other parameters were recorded from an electronic database. Results We enrolled 264 children, majority, 139 (53%) were below 5 years of age, 152 (58%) males, 112 (42%) females. BCG vaccination was given to 81 (30%) male and, 60 (23%) female children. 183 (69%) children had pulmonary symptoms, 81 (31%) had extra extrapulmonary tuberculosis. The commonest extrapulmonary manifestation was GIT 34 (13%), followed by CNS 27 (10%) cases. Cough was found in 54 (31%) followed by respiratory distress 49 (27%), almost all of them were below 5 years of age. CXR was performed in all cases, 85 (32%) didn’t have radiological findings. The frequency of BCG vaccination status, history of contact, measles about age gender, and systemic involvement was also analyzed and found significant results. 23 children, had a history of contact and measles both. Miliary was found in 6 (26%) cases, however, 22 (99%) of 23 didn’t have BCG vaccination. History of weight loss was found in 46 (33%) who either didn’t get BCG vaccination or didn’t remember (no BCG scar, 123), out of 92 children with weight loss 31 (34%) have contact history. Conclusion Diagnosing childhood tuberculosis in emergency with vague/overlapping clinical presentations is a dilemma. Clinical scoring system may not identify most cases, hence suspicion must be high in all suspected cases with prolonged history, contact tracing methods, weight loss or failure to gain weight, etc.