engleski

Childhood tuberculosis: case series

OBJECTIVES: Tuberculosis (TB) remains one of the leading causes of mortality worldwide and children have even higher mortality rate compared to other age groups. Severe forms of the disease (miliary TB and meningitis) are most frequently seen in younger children (<5 years). Croatia has a low incidence of TB and the diagnosis is often delayed due to lack of clinical suspicion. METHODS: The medical records of all pediatric patients with TB treated in University Hospital for Infectious Diseases, Zagreb between January 2003 and September 2018 were retrospectively reviewed. RESULTS: In total 11 cases of TB (5 girls ; 6 boys) with median age of 7, 16 years (1 month -16, 8 years) were treated. All patients were previously healthy. 4 patients (36%) haven`t received the BCG vaccine. Only one patient was from a population with high rate of TB (immigrant). A history of contact with a case of TB was present in 5 patients (45%). Four patients (36%) had pulmonary TB. 4 children presented with meningoencephalitis, and concomitant pulmonary miliary TB was present in 2 of them. One patient had spinal TB and in one case the diagnosis was based on clinical manifestation (fever of unknown origin), positive interferon-gamma release assay (IGRA) and history of exposure to TB. Case of a neonatal TB was identified in a child whose mother was recently diagnosed with TB. In all children usual treatment regimens (isoniazid, rifampin, ethambutol, pyrazinamide) were conducted through 6- 12 months. There was no identified drug-resistant TB and no cases of death caused by the disease. 73% of patients had favourable outcome, but in 3 children with TB meningoencephalitis neurological sequelae were present. CONCLUSION: Pulmonary TB and tuberculous meningitis were the most frequent clinical manifestations. Sequelae were found only in children with meningoencephalitis. Due to often rapid progression of the disease in children, establishing accurate diagnosis and therapy are crucial.

Tuberculosis ; children ; meningoencephalitis

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