Pediatric Tuberculosis at Moulay Youssef University Hopsital – Morocco
PDF

Keywords

Pediatric
Tuberculosis
Pulmonary
Lymph nodes

Categories

How to Cite

1.
Aharmim M, Bouti K, Soualhi M, Hanim FZ, Marc K, Zahraoui R, Benamor J, Bourkadi JE, Iraqi G. Pediatric Tuberculosis at Moulay Youssef University Hopsital – Morocco. Integr J Med Sci [Internet]. 2020 Jun. 20 [cited 2024 Dec. 22];1:17-22. Available from: https://mbmj.org/index.php/ijms/article/view/6

Abstract

Background: There are few studies on presentations, treatment, and outcomes of pediatric tuberculosis in Morocco. This study aimed to describe clinico-epidemiological profiles, laboratory findings, treatment, and outcomes of pediatric tuberculosis (TB) in a tertiary care hospital in Morocco.
Materials and Methods: This is a prospective, descriptive study undertaken in children diagnosed with TB between June 2011 and May 2012. Clinico-pidemiologicalprofiles, laboratory findings, treatment, and outcome of patients were recorded. Statistical significance of category variables was evaluated. Analysis was done on the SPSS package. Results were expressed as rates and proportions. The Chi-square test was used to test for statistical significance. 
Results: 53 children aged 2 to 16 years (mean age of 9±3.2) with TB diagnosis were enrolled in our study. 33 (62%) of patients were female. Common symptoms were fever, cough, chest pain, dyspnea, decreased appetite, and weight loss. The types of TB were: pulmonary TB (32, 60%), and extrapulmonary TB (21, 39.6%). The sites of pediatric extrapulmonary tuberculosis (EPTB) were: lymph nodes (7, 13.2%), peritoneal (6, 11.3%), meningeal (4, 7.5%) and osteoarticular (4, 7.5%). 24 (45,3%) of the patients had positive Calmette-Guérin vaccine scar, and 42(79.2%) of the patients had a positive tuberculin skin test. An adult TB contact was identified in 19 (35.8%) of the cases. On direct microscopy, acid-fast bacilli were found in 3 (5.6%) patients and positive cul¬ture for Mycobacterium tuberculosis was found in 2 (3.7%). Drug mono- or multi-resistance was not detected.
Conclusion: Paediatric TB in both pulmonary and extrapulmonary forms is a challenging diagnosis, and is a common occurrence in our setting. The diagnosis was based on a combination of epidemiological and clinical suspicion supported by the results of various investigations.

https://doi.org/10.15342/ijms.v1i1.4
PDF

References

Organization WH. Global tuberculosis report 2013: World Health Organization; 2013. https://apps.who.int/iris/bitstream/handle/10665/91355/9789241564656_eng.pdf?sequence=1.

Sreeramareddy CT, Ramakrishnareddy N, Shah RK, Baniya R, Swain PK. Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis. BMC Pediatr. 2010 Aug 9; 10:57. https://doi.org/10.1186/1471-2431-10-57

Wong KS, Chiu CH, Huang YC, Lin TY. Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994-1999. Acta Paediatr. 2001 Aug; 90(8):943-7. https://doi.org/10.1111/j.1651-2227.2001.tb02462.x

Marais BJ. Childhood tuberculosis: epidemiology and natural history of disease. Indian J Pediatr. 2011 Mar; 78(3):321-7. https://doi.org/10.1007/s12098-010-0353-1

Perez-Velez CM, Marais BJ. Tuberculosis in children. N Engl J Med. 2012 Jul; 367(4):348-61. https://doi.org/10.1056/nejmra1008049

Heymann SJ, Brewer TF, Wilson ME, Colditz GA, Fineberg HV. Pediatric tuberculosis: what needs to be done to decrease morbidity and mortality. Pediatrics. 2000 Jul; 106(1):E1. https://doi.org/10.1542/peds.106.1.e1

Nicol MP, Workman L, Isaacs W, Munro J, Black F, Eley B, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary tuberculosis in children admitted to hospital in Cape Town, South Africa: a descriptive study. The Lancet infect Dis. 2011Nov; 11(11):819-24. https://doi.org/10.1016/S1473-3099(11)70167-0

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. Lancet. 2005 Jan 8-14; 365(9454):130-4. https://doi.org/10.1016/S0140-6736(05)17702-2

Gulec SG, Telhan L, Kockaya T, Erdem E, Bayraktar B, Palanduz A. Description of pediatric tuberculosis evaluated in a referral center in istanbul Turkey. Yonsei Med J. 2012 Nov 1; 53(6):1176-82. https://doi.org/10.3349/ymj.2012.53.6.1176

Bibi H, Mosheyev A, Shoseyov D, Feigenbaum D, Kurzbart E, Weiller Z. Should bronchoscopy be performed in the evaluation of suspected pediatric pulmonary tuberculosis? .Chest. 2002 Nov; 122(5):1604-8. https://doi.org/10.1378/chest.122.5.1604

Huang YF, Nong BR, Chuang CM, Hsieh KS, Liu YC. Ten year experience of children with tuberculosis in southern Taiwan. J Microbiol Immunol Infect. 2009 Dec; 42(6):516-20. [Accessed 2th June 2021]. Available from: https://tmu.pure.elsevier.com/zh/publications/ten-year-experience-of-children-with-tuberculosis-in-southern-tai

Pineda PR, Leung A, Muller NL, Allen EA, Black WA, FitzGerald JM. Intrathoracic paediatric tuberculosis: a report of 202 cases. Tuber lung Dis. 1993 Aug; 74(4):261-6. https://doi.org/10.1016/0962-8479(93)90052-Y

Schaaf HS, Beyers N, Gie RP, Nel ED, Smuts NA, Scott FE, et al. Respiratory tuberculosis in childhood: the diagnostic value of clinical features and special investigations. Pediatr Infect Dis J. 1995 Mar; 14(3):189-94. [Accessed 27th May 2021]. Available from: https://journals.lww.com/pidj/Abstract/1995/03000/Respiratory_tuberculosis_in_childhood__the.4.aspx

Moyo S, Verver S, Mahomed H, Hawkridge A, Kibel M, Hatherill M, et al. Age-related tuberculosis incidence and severity in children under 5 years of age in Cape Town, South Africa. Int J Tuberc Lung Dis. 2010 Feb; 14(2):149-54. [Accessed 27th May 2021]. Available from: https://www.ingentaconnect.com/content/iuatld/ijtld/2010/00000014/00000002/art00005

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 D. 2012 May 15; 205 Suppl 2(Suppl 2):S199-208. https://doi.org/10.1093/infdis/jis008

Cherkaoui I, Sabouni R, Ghali I, Kizub D, Billioux AC, Bennani K, et al. Treatment default amongst patients with tuberculosis in urban Morocco: predicting and explaining default and post-default sputum smear and drug susceptibility results. PloS One. 2014 Apr 3; 9(4):e93574. https://doi.org/10.1371/journal.pone.0093574

Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Beyers N. The burden of childhood tuberculosis and the accuracy of community-based surveillance data. Int J Tuberc Lung Dis. 2006 Mar; 10(3):259-63. [Accessed 2th June 2021]. Available from: https://www.ingentaconnect.com/content/iuatld/ijtld/2006/00000010/00000003/art00007

Connell TG, Zar HJ, Nicol MP. Advances in the diagnosis of pulmonary tuberculosis in HIV-infected and HIVuninfected children. J Infect Dis. 2011 Nov; 204 Suppl 4 (Suppl 4):S1151-8. https://doi.org/10.1093/infdis/jir413

Nicol MP, Zar HJ. New specimens and laboratory diagnostics for childhood pulmonary TB: progress and prospects. Paediatr Respir Rev. 2011 Mar; 12(1):16-21. https://doi.org/10.1016/j.prrv.2010.09.008

Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet infect Dis. 2008 Aug; 8(8):498-510. https://doi.org/10.1016/S1473-3099(08)70182-8

Association AL. Tuberculosis fact sheet. Retrieved September. 2006; 12:2006.

Marais BJ, Pai M. New approaches and emerging technologies in the diagnosis of childhood tuberculosis. Paediatr Respiratory reviews. 2007 Jun; 8(2):124-33. https://doi.org/10.1016/j.prrv.2007.04.002

Zar HJ, Pai M. Childhood Tuberculosis–a new era. Paediatr Respir Rev. 2011 Mar; 12(1):1-2. https://doi.org/10.1016/j.prrv.2010.09.004

Menzies D. What does tuberculin reactivity after bacille Calmette-Guerin vaccination tell us? Clin Infect Dis. 2000 Sep; 31 Suppl 3:S71-S4. https://doi.org/10.1086/314075

Marais BJ. Advances in the clinical diagnosis of TB in children. Pediatr Res. 2008 Feb; 63(2):116-. https://doi.org/10.1203/PDR.0b013e3181646cdf

Hatherill M, Hawkridge T, Zar HJ, Whitelaw A, Tameris M, Workman L, et al. Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis? Arch Dis Child. 2009 Mar; 94(3):195-201.https://doi.org/10.1136/adc.2007.136929

Magdorf K, Detjen AK. Proposed management of childhood tuberculosis in low-incidence countries. Eur J Pediatr. 2008 Aug;167(8):927-38. https://doi.org/10.1007/s00431-008-0730-1

Guthmann J, de La Rocque F, Boucherat M, van Cauteren D, Fonteneau L, Lécuyer A, et al. [BCG vaccine coverage in private medical practice: First data in children below two years old, seven months after the end of compulsory vaccination in France]. Arch Pediatr francaise de pediatrie. 2009 May; 16(5):489-95.https://doi.org/10.1016/j.arcped.2009.01.006

Aycicek A, Aktas G, Celen O. [Clinical, radiological and epidemiological characteristics of 69 pediatric tuberculosis cases from Sanliurfa district]. Turkish Pediatr J. 2006; 49: 205-12.

Cosar H, Onay H, Bayram N, Ozkınay F. The evaluation of the epidemiological and clinical findings and the prognosis of the 44 pediatric tuberculosis patients. J Pediatr Infect. 2008; 2:1-6.

Phongsamart W, Kitai I, Gardam M, Wang J, Khan K. A population-based study of tuberculosis in children and adolescents in Ontario. Pediatr Infect Dis J. 2009 May; 28(5):416-9. https://doi.org/10.1097/inf.0b013e3181920d4d

Maltezou H, Spyridis P, Kafetzis D. Extra-pulmonary tuberculosis in children. Arch

Child. 2000; 83(4):342-6. http://dx.doi.org/10.1136/adc.83.4.342

Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a hospital-based retrospective study. BMC infect Dis. 2008 Jan 24; 8:8. https://doi.org/10.1186/1471-2334-8-8

De Villiers RV, Andronikou S, Van de Westhuizen S. Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high kilovolt radiographs. Australas Radiol. 2004 Jun; 48(2):148-53. 10.1111/j.1440-1673.2004.01276.x

Khemiri M, Labessi A, Zouari S, Borgi A, Ben Mansour F, Oubich F, et al. [Tuberculosis in childhood: clinical features and problems in diagnosis. Report of 30 cases]. Tunis Med. 2009 Jan; 87(1):61-7. [Accessed 25th May 2021].Available from: https://www.latunisiemedicale.com/article-medicale-tunisie_1048_en.

Davidson RN. Childhood tuberculosis--problems ahead. Trans R Soc of Trop Med Hyg. Jan-Feb 2000; 94(1):5-6. https://doi.org/10.1016/S0035-9203(00)90415-2

Guidance for national tuberculosis programmes on the management of tuberculosis in children. Chapter 2: antituberculosis treatment in children. Int J Tuberc Lung Dis. 2006; 10(11):1205-11. [Accessed 25th May 2021].Available from: https://apps.who.int/iris/bitstream/handle/10665/112360/9789241548748_eng.pdf?sequen

Swaminathan S, Rekha B. Pediatric tuberculosis: global overview and challenges. Clin Infect Dis. 2010; 50 (3):184-94. https://doi.org/10.1086/651490

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2014 Mohamed Aharmim et al.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...