Pattern of Childhood Tuberculosis in the Outpatient Department of a Tertiary Level Hospital in Dhaka City
International Journal of Infectious Diseases and Therapy
Volume 5, Issue 2, June 2020, Pages: 23-28
Received: Mar. 22, 2020; Accepted: Apr. 9, 2020; Published: May 15, 2020
Views 77      Downloads 31
Authors
Md. Mozammel Haque, Department of Pediatrics, 250 Bedded Hospital, Moulvibazar, Bangladesh
Md. Abdullah-Al-Maruf, Department of Medicine, 250 Bedded Hospital, Moulvibazar, Bangladesh
Abdullah Al Baki, Department of Pediatrics, 250 Bedded Hospital, Moulvibazar, Bangladesh
A. Z. M. Motiur Rahman, Department of Pediatrics, 250 Bedded Hospital, Moulvibazar, Bangladesh
Md. Arif Rabbany, Department of Pediatrics, Upazilla Health Complex, Sreepur, Gazipur, Bangladesh
Dhiman Chowdhury, Department of Pediatrics, Chattogram Medical College Hospital, Chattogram, Bangladesh
Muhammad Jabed Bin Amin Chowdhury, Department of Pediatrics, Chattogram Medical College Hospital, Chattogram, Bangladesh
Muhammad Ismail Hasan, Department of Pediatrics, Sadar Hospital, Laxmipur, Bangladesh
Mohammad Morshad Alam, Department of Pediatrics, Sadar Hospital, Laxmipur, Bangladesh
Jugindra Singha, Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh
Md. Shohidul Islam Khan, Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh
Md. Humayan Kabir, Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh
Mohammed Golam Mowla, Department of Pediatrics, Upazilla Health Complex, Muktagacha, Mymensingh
Kamrunnaher Shultana, Department of Pediatrics and PICU, Square Hospitals Ltd., Dhaka, Bangladesh
Article Tools
Follow on us
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.
Keywords
Childhood TB, Pulmonary TB, Extra-pulmonary TB
To cite this article
Md. Mozammel Haque, Md. Abdullah-Al-Maruf, Abdullah Al Baki, A. Z. M. Motiur Rahman, Md. Arif Rabbany, Dhiman Chowdhury, Muhammad Jabed Bin Amin Chowdhury, Muhammad Ismail Hasan, Mohammad Morshad Alam, Jugindra Singha, Md. Shohidul Islam Khan, Md. Humayan Kabir, Mohammed Golam Mowla, Kamrunnaher Shultana, Pattern of Childhood Tuberculosis in the Outpatient Department of a Tertiary Level Hospital in Dhaka City, International Journal of Infectious Diseases and Therapy. Vol. 5, No. 2, 2020, pp. 23-28. doi: 10.11648/j.ijidt.20200502.11
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Hirozi E. Studies on the Cause of Death of the Registered TB Patients. Kurume Med J 1970; 17 (2): 55-60.
[2]
Raviglione M, Kochi A. Global Epidemiology of Tuberculosis. Morbidity and Mortality ofa Worldwide Epidemic. JAMA 1995; 273 (3): 220-226.
[3]
Shanmuganathan R, Shanmuganathan ID. Clinical Manifestation and Risk Factors of Tuberculosis Infection in Malaysia: Case Study of a Community Clinic. Glob J Health Sci 2015; 7 (4): 110-120.
[4]
Au-Yeung C, Kanters S, Ding E, Glaziou P, Anema A, Cooper CL, et al. Tuberculosis Mortality in HIV-Infected Individuals: A Cross-national Systematic Assessment. Clinical Epidemiology 2011; 3: 21-29.
[5]
Rein MJ, Peter JD. The Global Burden of Latent TB Infection: A Re-estimation Using Mathemetical Modeling. PloS Med 2016; 13 (10): e100 2152.
[6]
Dodd P, Gardiner E, Coghlan R, Seddon J. Burden of Childhood Tuberculosis in 22 High-Burden Countries: A Mathematical Modeling Study. The Lancet Global Health 2014; 2 (8): 453-459.
[7]
Rieder H. Annual Risk of Infection with Mycobacterium Tuberculosis. ERJ 2005; 25: 181-185.
[8]
Walls T, Shingadia D. Global Epidemiology of Pediatric Tuberculosis. J Infect 2004; 48 (1): 13-22.
[9]
Zafar U, Naser A, Huque R, Begum V. Public-Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB Patients. World Medical & Health Policy 2010: 2 (1): 210-227.
[10]
Perez-Velez CM, Marais BJ. Tuberculosisin Children. NEJM 2012; 367 (4): 348–361.
[11]
Nejat S, Buxbaum C, Eriksson M, Pergert M, Bennet R. Pediatric Tuberculosis in Stockholm. PIDJ 2012; 31 (3): 224-227.
[12]
Endorf F, Garrison M, Klein M, Richardson A, Rivara F. Characteristics, Therapies and Outcome of Children With Necrotizing Soft Tissue Infections. PIDJ 2012; 31 (3): 221-223.
[13]
Marais B, Gupta A, Starke J, El Sony A. Tuberculosis in Women and Children. The Lancet 2010; 375 (9731): 2057-2059.
[14]
Soumya S, Banu R. Pediatric Tuberculosis: Global Overview and Challenges. ClinInfec Dis 2010: 50 (3): 184-194.
[15]
Hoskyns W. Pediatric Tuberculosis. Postgrad Med J 2003; 79 (931): 272-278.
[16]
Topley JM, Maher D, Mbewe LN. Transmission of Tuberculosis to Contacts of Sputum Positive Adults in Malawi. Arch Dis Child 1996; 74 (2): 140–143.
[17]
Noertjojo K, Tam CM, Chan SL, Chan-Yeung MM. Extra-pulmonary and Pulmonary Tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2002; 6 (10): 879–886.
[18]
Musellim B, Erturan S, Sonmez DE, Ongen G. Comparison of Extra-Pulmonary and Pulmonary Tuberculosis Cases: Factors Influencing the Site of Reactivation. Int J Tuberc Lung Dis 2005; 9: 1220–1223.
[19]
Sankalp Y, Gautam R. Primary Extra-Pulmonary Multidrug Resistant Tuberculosis of the Sternum without HIV Infection. JCDR 2017; 11 (1): 1-3.
[20]
Starke JR. Pediatric Tuberculosis: Time for a New Approach. Tuberculosis (Edinb) 2003; 83: 208–12.
[21]
Starke JR. Childhood Tuberculosis: A Diagnostic Dilemma. Chest 1993; 104: 329–333.
[22]
Eamranond P, Jaramillo E. Tuberculosis in Children: Reassessing the Need for Improved Diagnosis in Global Control Strategies. IntJTuberc Lung Dis 2000; 5: 594–603.
[23]
Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced Sputum Versus Gastric Lavage for Microbiological Confirmation of Pulmonary Tuberculosis in Infants and Young Children: A Prospective Study. Lancet2005; 365: 130–134.
[24]
Cruz AT, Starke JR. Clinical Manifestations of TB in Children. PediatrRespir Rev 2007; 8: 107–117.
[25]
Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M, et al. Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus from an Expert Panel. J Infect Dis 2012; 205 (2): 199-208.
[26]
Zar HJ, Connell TG, Nicol M. Diagnosis of Pulmonary Tuberculosis in Children: New Advances. Expert Rev Anti Infect Ther 2010; 8 (3): 277-288.
[27]
Lambregts-Van Weezenbeek CS, Cobelens FG, Mensen EA, CommissievoorPraktische T. The Tuberculin Skin Test in the Netherlands: New Policies for an Old Test; Guideline from the Netherlands Tuberculosis Control Policy Committee. Ned TijdschrGeneeskd 2003; 147 (12): 543-546.
[28]
Jahromi MK, Mood BS. Pulmonary Tuberculosis in Children.. Int J Infect 2014; 1 (3): e21116.
[29]
Phongsamart W, Kitai I, Gardam M, Wang J, Khan K. A Population-Based Study of Tuberculosis in Children and Adolescents in Ontario. PIDJ 2009; 28 (5): 416-419.
[30]
Comstock GW, Livesay VT, Woolpert SF. The Prognosis of a Positive Tuberculin Reaction in Childhood and Adolescence. Am J Epidemiol 1974; 99 (2): 131-138.
[31]
Almeida LMD, Barbieri MA, Da Paixao AC, Cuevas LE. Use of Purified Protein Derivative to Assess the Risk of Infection in Children in Close Contact with Adults with Tuberculosis in a Population with High Calmette-Guerin-Bacillus Coverage. PIDJ 2001; 20 (11): 1061–1065.
[32]
Connell TG, Ritz N, Paxton GA, Buttery JP, Curtis N. A Three-Way Comparison of Tuberculin Skin Testing, QuantiFERON-TB Gold and T-SPOT. TB in Children. PLoS ONE 2008; 3 (7): 1-7.
[33]
Pai M, Riley LW, Colford JM. Interferon- Gamma Assays in the Immunodiagnosis of Tuberculosis: A Systematic Review. The Lancet Infectious Diseases 2004; 4 (12): 761–776.
[34]
Hill PC, Ota MO. Tuberculosis Case-Contact Research in Endemic Tropical Settings: Design, Conduct, and Relevance to Other Infectious Diseases. The Lancet Infectious Diseases 2010; 10 (10): 723–732.
[35]
Marais BJ, Gie RP, SchaafHS, Hesseling AC, Obihara CC, Starke JJ, et al. The Clinical Epidemiology of Childhood Pulmonary Tuberculosis: A Critical Review of Literature from the Pre-Chemotherapy Era. Int J Tuberc Lung Dis 2004; 8 (3): 278–285.
[36]
Marais BJ1, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, et al. The Natural History of Childhood Intra-thoracic Tuberculosis: A Critical Review of Literature from the Pre-Chemotherapy Era. Int J Tuberc Lung Dis 2004; 8 (4): 392–402.
[37]
Seddon JA, Delane S. Epidemiology and Disease Burden of Tuberculosis in Children: A Global Perspective. Infect Drug Resist 2014; 7: 153–165.
[38]
Nelson LJ, Wells CD. Global Epidemiology of Childhood Tuberculosis. Int J Tuberc Lung Dis 2004; 8 (5): 636–647.
[39]
Hsueh PR, Liu YC, So J, Liu CY, Yang PC, Luh KT. Mycobacterium Tuberculosis in Taiwan. J Infect 2006; 52 (2): 77–85.
[40]
Sandhu GK. Tuberculosis: Current Situation, Challenges and Overview of its Control Programs in India. J Glob Infect Dis 2011; 3 (2): 143–150.
[41]
Zaman K. Tuberculosis: A Global Health Problem. J Health PopulNutr. 2010; 28 (2): 111–113.
[42]
Sume G, Etogo D, Kabore S, Gnigninanjouena O, Epome S, Metchendje J. Seroprevalence of Human Immunodeficiency Virus Infection Among Tuberculosis Patients In The Nylon District Hospital Tuberculosis Treatment Centre. EAMJ 2008; 85 (11): 529-536.
[43]
Fanning A. Tuberculosis: Extra-pulmonary Disease. CMAJ 1999; 160: 1597- 1603.
[44]
Haegi V. Extra-Pulmonary Tuberculosis Today. Schweiz Med Wonschenschr 1987; 117 (38): 1403-1408.
[45]
Regie SS. Clinical Profile of Extra-Pulmonary Tuberculosis Cases Admitted and Diagnosed in a Tertiary Government Hospital from January 2006 to June 2010. PIDSP Journal 2013; 13 (2): 77-84.
[46]
Islam SMS, Ahmed S, Amin MR, Begum V, Kabir ARML, Mollah MAH, et al, editors. National Guidelines for the Management of Tuberculosis in Children. 2nd ed. Bangladesh: WHO: 2016.
[47]
Ullah S, Shah SH, Rehman AU, Kamal A, Begum N. Tuberculous Lymphadenitis in Afghan Refugees. J Ayub Med Coll Abbottabad 2002; 14 (2): 22–23.
[48]
Van Loenhout-Rooyackers J, Laheij R, Richter C, Verbeek A. Shortening the Duration of Treatment for Cervical Tuberculous Lymphadenitis. ERJ 2000; 15 (1): 192.
[49]
Hatwal D, Chaudhari S, Joshi AK, Tarhaur VK. Patterns of Extra-Pulmonary Tuberculosis in Children: A Hospital Based Study. IJCH 2013; 25 (1): 22-27.
[50]
Napolean GS, Mercedes MP, Marte H, Hugo JO. Pulmonary Tuberculosis: Symptoms Diagnosis and Treatment. 19 Years Experience in a Third Level Pediatric Hospital. BMC Infect Dis 2014; 14 (1): 401.
[51]
Gosai DK, Gosai JB, Shukla OS. Study of Clinical Profile of Childhood Extra-Pulmonary Tuberculosis. Int J Res Med Sci 2014; 2 (2): 501-505.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186