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Pediatric Extrapulmonary Tuberculosis: Clinical Spectrum, Risk Factors and Diagnostic Challenges in a Low Prevalence Region.
Pediatric Infectious Disease Journal 2016 June 17
BACKGROUND: Children are at higher risk of tuberculosis (TB) dissemination and extrapulmonary disease, contributing greatly to TB associated morbidity and long-term sequelae. However, there are very few studies that assess the impact and clinical spectrum of pediatric extrapulmonary TB (EPTB) in low-prevalence regions.
METHODS: Children <18 years of age diagnosed with TB in Madrid region (2005-2013) were reviewed. We compared the epidemiology, clinical characteristics, and the performance of diagnostic tests in childhood extrapulmonary and pulmonary disease. We performed a multivariate logistic regression to identify factors associated with EPTB.
RESULTS: During the study period, 93 of 526 pediatric TB cases had EPTB (17.7%). The most common site was lymphatic TB (34.5%). The source case was not identified in most extrapulmonary cases, contrary to pulmonary TB (28% vs. 63.3%; p<.001). The TST induration was smaller in EPTB cases (<5mm 22% vs. 5%; p<.001), but the sensitivity of IGRAs was similar (76.9% vs 79.4%). Children with EPTB presented higher rate of bacteriologic confirmation (66% vs 49.4%; p<.01), and higher incidence of MDR TB (8.2% vs 1.6%; p=.03). Complications were present in 40.2% extrapulmonary cases. EPTB was associated with the child´s foreign origin (OR 2.3[1.1-5.3]), immune disorders (OR 5.8[1.9-17.1]) and drug resistance (OR 2.4[1.1-5.4]).
CONCLUSIONS: In our low-prevalence region, childhood EPTB was linked to immigrant status, immune disorders and drug resistance, and presented high rate of complications. Our study underscores the relevance of improved diagnostic tools and systematic TB screening in high risk populations.
METHODS: Children <18 years of age diagnosed with TB in Madrid region (2005-2013) were reviewed. We compared the epidemiology, clinical characteristics, and the performance of diagnostic tests in childhood extrapulmonary and pulmonary disease. We performed a multivariate logistic regression to identify factors associated with EPTB.
RESULTS: During the study period, 93 of 526 pediatric TB cases had EPTB (17.7%). The most common site was lymphatic TB (34.5%). The source case was not identified in most extrapulmonary cases, contrary to pulmonary TB (28% vs. 63.3%; p<.001). The TST induration was smaller in EPTB cases (<5mm 22% vs. 5%; p<.001), but the sensitivity of IGRAs was similar (76.9% vs 79.4%). Children with EPTB presented higher rate of bacteriologic confirmation (66% vs 49.4%; p<.01), and higher incidence of MDR TB (8.2% vs 1.6%; p=.03). Complications were present in 40.2% extrapulmonary cases. EPTB was associated with the child´s foreign origin (OR 2.3[1.1-5.3]), immune disorders (OR 5.8[1.9-17.1]) and drug resistance (OR 2.4[1.1-5.4]).
CONCLUSIONS: In our low-prevalence region, childhood EPTB was linked to immigrant status, immune disorders and drug resistance, and presented high rate of complications. Our study underscores the relevance of improved diagnostic tools and systematic TB screening in high risk populations.
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