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Open Access Highly Accessed Research article

Pulmonary Tuberculous: Symptoms, diagnosis and treatment. 19-year experience in a third level pediatric hospital

Napoleón González Saldaña1, Mercedes Macías Parra1, Marte Hernández Porras1, Pedro Gutiérrez Castrellón2, Valeria Gómez Toscano1 and Hugo Juárez Olguin3*

Author Affiliations

1 Servicio de Infectología, Instituto Nacional de Pediatría, (INP), Mexico City, Mexico

2 Departamento de Investigación, INP, Mexico City, Mexico

3 Laboratorio de Farmacología, INP, Facultad de Medicina, Universidad Nacional Autónoma de México, Av Imán #1, 3er piso, Col Cuicuilco, CP 04530 Mexico City, Mexico

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BMC Infectious Diseases 2014, 14:401  doi:10.1186/1471-2334-14-401

Published: 19 July 2014

Abstract

Background

Pulmonary tuberculosis (PTB) is an infectious disease that involves the lungs and can be lethal in many cases. Tuberculosis (TB) in children represents 5 to 20% of the total TB cases. However, there are few updated information on pediatric TB, reason why the objective of the present study is to know the real situation of PTB in the population of children in terms of its diagnosis and treatment in a third level pediatric hospital.

Methods

A retrospective study based on a revision of clinical files of patients less than 18 years old diagnosed with PTB from January 1994 to January 2013 at Instituto Nacional de Pediatria, Mexico City was carried out. A probable diagnosis was based on 3 or more of the following: two or more weeks of cough, fever, tuberculin purified protein derivative (PPD) +, previous TB exposure, suggestive chest X-ray, and favorable response to treatment. Definitive diagnosis was based on positive acid-fast bacilli (AFB) or culture.

Results

In the 19-year period of revision, 87 children were diagnosed with PTB; 57 (65.5%) had bacteriologic confirmation with ZN staining or culture positive (in fact, 22 were ZN and culture positive), and 30 (34.5%) had a probable diagnosis; 14(16.1%) were diagnosed with concomitant disease, while 69/81 were immunized. Median evolution time was 21 days (5–150). Fever was found in 94.3%, cough in 77%, and weight loss in 55.2%. History of contact with TB was established in 41.9%. Chest X-ray showed consolidation in 48.3% and mediastinal lymph node in 47.1%. PPD was positive in 59.2%, while positive AFB was found in 51.7% cases. Culture was positive in 24/79 patients (30.4%), PCR in 20/27 (74.1%). 39 (44.8%) patients were treated with rifampin, isoniazid, and pyrazinamide while 6 (6.9%) received the former drugs plus streptomycin and 42 (48.3%) the former plus ethambutol. There were three deaths.

Conclusions

PTB in pediatric population represents a diagnostic challenge for the fact that clinical manifestations are unspecific and the diagnosis is not confirmed in all cases; that is why clinical suspicion, X-ray findings and PPD are indispensable for opportune start of treatment.

Keywords:
Tuberculosis; Pulmonary tuberculosis; Tuberculosis in children