First Year Of Illness Research Articles

On Pulmonary Tuberculosis in Children with a Special View to the Prognosis.

Summary.The aim of this work has been to throw some light upon the prognosis for children with active pulmonary tuberculosis. The material comprises children admitted to the Fuglebakken Hospital in the period of 1928–1936. Reexamination of these children was carried out in the autumn 1937.Of 267 children 51 died, among, whom tuberculous meningitis or miliary tuberculosis was the direct cause of death in 46, while 5 died of the pulmonary affection. Among the 51 fatal cases 48 died within one year after admission to the hospital, 40 even within six months after admission. From this it may be concluded that if the children pulled through the first year of illness they have a good chance of surviving.The prognosis differs greatly in the various age‐classes. Of 55 children under 1 year 24 died; of 56 children at the age of 1–2 years 14 died; of 41 children at the age of 2–3 years 5 died; of 85 children at the age of 3–7 years 7 died; and of 30 children at the age of 7–14 years 1 died.On reexamination of 216 survivors (208 of whom were roentgenographed at the reexamination) only 9 were found who had to be designated as being ill yet. From this the conclusion may be drawn that if the children survive the first year of illness they stand a very good chance of recovering completely. This applies to all age‐classes.For these reasons, in judging of the prognostic significance of various symptoms and objective findings the case mortality is used exclusively as criterion.As roentgenography is considered the most important method of examination, particular efforts have been made to elucidate what prognostic conclusions may be drawn from the roentgenogram at the institution of treatment. From Tables 4 and 5 it is evident that the extension of the tuberculous processes in the lungs essentially is decisive of the prognosis while the location of the processes plays no demonstrable role.Miliary dissemination in both lungs was demonstrated in 19 cases; 17 of these patients died, while 2 have recovered completely. So cases with this form of tuberculosis are not the be considered altogether hopeleses.Exudative pleurisy was found in 15 children; none of them died.Gastric lavage for examination for the presence of tubercle bacilli was performed in 257 out of 267 cases. Tubercle bacilli were demonstrated in the stomach washing in 233, in 22 of these cases by direct microscopy. With this method of examination, then, it has been possible to demonstrate the presence of tubercle bacilli in more than 90 % of children with active pulmonary tuberculosis. The demonstration of tubercle bacilli by direct microscopy has proved to imply a serious aggravation of the prognosis; this applies to all age‐classes (cf. Table 8).All the children were tuberculin‐positive; 244 gave a positive reaction on the first tuberculin test (Pirquet or Moro (or Moro tape test)).The sedimentation test has proved to be of only slight prognostic value.Auscultation gave normal or uncertain findings in two thirds of the cases, even in several with extensive changes in the lungs.The subjective symptoms have been few and non‐characteristic; they have not given any information of prognostic value. Nor have they been of any diagnostic significance.On ordinary physical examination, bitonal cough in infants and erythema nodosum are the only phenomena that may give the physician a reasonable suspicion about the presence of pulmonary tuberculosis.Extrapulmonary complications (apart from meningitis) have been rare; and they appear not to aggravate the prognosis.In 167 cases it has been practicable to establish a known source of infection, and it was intrafamilial in 120 of these cases. In children over 1 year the prognosis appears not to be worse in those cases where the source of infection is known or even intrafamilial.