Pattern of Childhood Tuberculosis in the Outpatient Department of a Tertiary Level Hospital in Dhaka City

Md Mozammel Haque,Kamrunnaher Shultana,Mohammed Golam Mowla,Md Abdullah-Al-Maruf,A Z M Motiur Rahman,Muhammad Jabed Bin Amin Chowdhury,Abdullah Al Baki,Jugindra Singha,Muhammad Ismail Hasan,Md Humayan Kabir,Md Shohidul Islam Khan,Md Arif Rabbany,Mohammad Morshad Alam,Dhiman Chowdhury

doi:10.11648/j.ijidt.20200502.11

Md Mozammel Haque, Kamrunnaher Shultana + Show 12 more

Open Access

https://doi.org/10.11648/j.ijidt.20200502.11

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Abstract

Introduction: Tuberculosis (TB) in children is increasingly becoming an important cause of global child morbidity and mortality. Objective: The objective of this study was to evaluate the clinical spectrum of TB in children under the age of 15 years and document any changes that occur over time. Materials & Methods: This observational study was conducted in the pediatric outpatient department (OPD) of 250 Bedded TB Hospital, Shyamoli, Dhaka, from October’2016 to January’2017. A total 71 children of both sex up to 15 years of age, who were diagnosed as having TB and attended the pediatric OPD of TB hospital during the four months study period were enrolled. The data was analyzed on the basis of patient’s age, gender, socioeconomic status, mode of presentation, BCG vaccination status, history of contact with smear positive TB patient, clinical findings, investigations and associated co-morbidities. Results: This study revealed that among the 71 cases of TB, (72%) had extra-pulmonary TB (EPTB) and (28%) had pulmonary TB (PTB), the commonest age group was 6 to 15 years with male preponderance (51%). Pulmonary TB was diagnosed mostly clinically (60%) followed by positive sputum smear result (20%), gastric aspirate for acid-fast bacilli AFB (5%) and sputum for Gene Xpert (5%). Distribution of extra-pulmonary TB (EPTB) according to the organ involvement was TB lymphadenitis (49%), osteoarticular TB (19.6%) and abdominal TB (5.9%). Cervical lymphadenopathy was the commonest presentation (76%) among the EPTB cases. Tuberculin skin test (TST) was positive in (69%) cases. Among the total cases (90%) children had TB alone whereas (10%) had other co-morbid disease along with TB. Conclusion: Extra-pulmonary TB (EPTB) was more prevalent among the childhood TB cases in a tertiary level set up where cervical TB lymphadenitis was the commonest.

Highlights

TB in children is increasingly becoming an important cause of global child morbidity and mortality
The children who were already diagnosed as TB patient in this hospital or elsewhere, already on anti-TB drugs or going to be introduced anti-TB therapy who came to the outpatient department (OPD) of 250 Bedded TB Hospital during the four months period were sequentially enrolled
For the confirmation of TB in children, case specific diagnostic modalities were used by the primary attending physician like clinical response to anti-TB therapy, Tuberculin skin test (TST), smear test, chest x-ray, fine needle aspiration cytology (FNAC) or biopsy etc

Summary

Introduction

Tuberculosis (TB) in children is increasingly becoming an important cause of global child morbidity and mortality. Results: This study revealed that among the 71 cases of TB, (72%) had extra-pulmonary TB (EPTB) and (28%) had pulmonary TB (PTB), the commonest age group was 6 to 15 years with male preponderance (51%). WHO in 2007 showed that smear-positive TB in children aged 14 years accounted for (0.6%–3.6%) of all reported cases and the majority reside in Africa and Southeast Asia [4]. This finding suggests that children in developing countries will emerge as a high risk group eventually. TB in children is increasingly becoming an important cause of global child morbidity and mortality

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