Journal Reading

Paediatric Tuberculosis at a
Referral Hospital in Istanbul
Analysis of 250 Case
Oleh
Wilda Suci Hidayah S.Ked

Perseptor:
dr. Aspri Sulanto, Sp.A

KEPANITRAAN KLINIK
RSPBA TAHUN 2017
INTRODUCTION
Tuberculosis (TB) still the 8th leading
cause of death worldwide with 8.7
million new cases and 1.4 million
deaths each year.

Turkey has a prevalence of TB 21 per

100,000 population (44.1 per 100,000
population in Istanbul) as well as
incidence in children under 13 years
constituting 13.7% of all cases.
 Introduction
High Prevalence and Mortality of TB

Contact History
"Pediatric TB poses a diagnostic Clinical Features
challenge because, Microbiological Diagnostic Tools Used
confirmation rates are low”. Radiological Findings
METHODS
 METHODS
Types of Research : Decriptive Research

Method of Research : Retrospektif

Place & Time Research : Bakirkoy Maternity and Children’s Training

and Educational Hospital (BEH) November 2014- December 2010

Sample : 250 sample (age of 2-179 month)

Data retrieval : Secondary Data (Medical Records) November 2014-

December 2010
RESULTS
 Result
• Characteristics of Pediatric TB Based on Clinical Presentation
• Characteristics of Pediatric TB Based on History of Contact with Previous TB Patients
• Characteristics of Pediatric TB Based on Clinical Symptoms
• Characteristics of Child TB Patients Based on Diagnostic test
• Characteristics of Pediatric TB Based on Radiological Examination
DISCUSSION
 Discussion
• Childhood TB has some unique features it is less often
bacteriologically confirmed compared with adult TB cases due
to its paucibacillary nature, and it is associated with a greater
likelihood of extrapulmonary and disseminated
presentations.

• Diagnosing TB in a child is often based on:

(1) Contact History with an infectious case
(2) A positive TST ( or interferon-gamma release assay)
(3) Clinical Features
(4) Radiological Findings
 Discussion
1. Contact history
• In this study → Contact history was present in 62%.
• WHO → all children aged 0–4 years, regardless of symptoms
and children aged 5 years and above who are symptomatic and
have been in close contact with a TB case be evaluated for TB.
• Previous Research (Wu, et al)→ reported that among 1212
pediatric patients with TB, 364 (31%) patients had a contact
history at home
• Previous Research (Buonsenso, et all)→ A 20-year study
conducted in Italy showed that a history of contact with a
patient with active TB was significantly associated with
pulmonary TB.
 Discussion
2. Tuberkulin Skin Test (TST)
• In this study → 53,3 % positivity of TST
• Previous Research (Pekcan,et all)→ 53,3 %
positivity of TST
• There are a number of methods for
performing TSTs, but the Mantoux method is
recommended.
 Discussion
3 . Clinical Features
• In this study → the most common symptoms were a
cough (69.5%), a long-standing fever (43.1%), and night
sweats (26.2%).
• Previous Research (Bayhan, et al)→ the most common
symptoms were night sweats and fever were reported
in 35.7% and 21.4% of patients.
• A twenty-year restrospective study (Buonsenso, et all)
→ A combination of cough, fever, and night sweats has
been reported to be the most common clinical finding
in TB.
 Discussion
4. Radiological Findings
• In this study →122 patients (50%) had solely
intrathoracic LAP.
• Previous Research →In Iran, pulmonary radiologic
features were studied in 70 children confirmed to
have TB over a five-year period.

“The most common feature was hilar/mediastinal LAP (85%)”.

CONCLUSIONS
 Conclusions
• Pediatric TB poses a diagnostic challenge because
paucibacillary nature. Diagnosing TB in a child is often
based on Contact History with an infectious case, A
positive TST ( or interferon-gamma release assay),
Clinical Features, and Radiological Findings.
• Presence of contact history directed us to search for TB
in children with nonspecific symptoms even if physical
examinations were normal.
• Some children who were close contacts to TB cases were
identified to have TB before development of symptoms.
THANK YOU
Discussion
• Childhood TB has some unique features it is less often
bacteriologically confirmed compared with adult TB
cases due to its paucibacillary nature, and it is
associated with a greater likelihood of
extrapulmonary and disseminated presentations.

- In this study (Turkey) → Extrapulmonary (35%)

- Taiwanese study → Extrapulmonary tissues (24.8%)
- Ethiopia → Extrapulmonary tissues (47.4%)
- India → Extrapulmonary tissues (46%)