1628. Pulmonary Tuberculosis in Children: Review of 19 Years in a Third Level Hospital
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

Tuberculosis in children accounts for 5 to 20% of the total of TB cases. There is an underegistry of cases due to difficulties in establishing the diagnosis. Updated information is scanty and in most cases it is from studies in developed countries, so it is convenient to know the situation in our setting.

Methods:

We reviewed the clinical files of all patients diagnosed with pulmonary tuberculosis (PTB) at the Instituto Nacional de Pediatría in Mexico City from January 1994 to January 2013. A probable diagnosis was based on 3 or more of the following: cough during two or more weeks, fever, PPD +, Combe +, chest X-ray suggestive, and favorable response to treatment. When BAAR or culture were positive, the diagnosis was definitive. 

Results:

During this period, 84 children were diagnosed with PTB, 57 (67.8%) had bacteriologic confirmation and 27 (32.1%) had a probable diagnosis. The median age was 3 years (3 months to 17 years), 45 patients (53.6%) were under 5 years and 14 (16.7%) were under one year of age, 11 (13.1%) had concomitant disease, 67/79 had been immunized. The time course had a median of 21 days (5-150). All patients had signs and symptoms such as fever, cough, and weight loss, in 96.4%, 78.6% and 57.1% respectively. There was epidemiologic history in 40%. The chest X-ray showed consolidation in 51.2% and mediastinal lymph node in 50%. PPD was positive in 60.7%. BAAR in gastric lavage was positive in 49.1%, 77.8% in sputum, and 80% in bronchial lavage; culture was positive in 24/79 patients (30.4%), PCR in 20/27 (74.1%); 39 patients (46.4%) were treated with rifampin, isoniazide, pirazinamide; 45 patients (53.6%) were treated with rifampin, isoniazide and pirazinamide, adding streptomycin in 6 and ethambutol in 39, with a good clinical course. One patient who had AIDS, multiple drug resistant PTB and poor treatment compliance died.

Conclusion:

PTB in children is a diagnostic challenge because of unspecific clinical manifestations and the low yield of M. tuberculosis retrieval. It is crucial to have a clinical suspicion along with radiological and epidemiological findings in order to establish the diagnosis.

Napoleon Gonzalez Saldaña, MD, Patricia Saltigeral Simental, Marte Hernández Porras and Valeria Gómez Toscano, Infectious Disease, instituto nacional de pediatria, Mexico, Mexico

Disclosures:

N. Gonzalez Saldaña, None

P. Saltigeral Simental, None

M. Hernández Porras, None

V. Gómez Toscano, None

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