Case management of childhood tuberculosis in children’s hospitals in Khartoum (original) (raw)
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Sudanese Journal of Paediatrics, 2021
The World Health Organization report in 2018 estimated 234,000 deaths due to tuberculosis (TB) in children less than 15 years; 40,000 of them occurring in human immunodeficiency virus (HIV) infected children. These deaths represent 15% of all TB deaths. This study aimed to determine the clinical spectrum and outcome of childhood TB at Mohamed Alamin Hamid Pediatric Hospital TB management unit. Retrospective observational hospitalbased study was conducted during January 2017-December 2018, in children aged 0-18 years who were diagnosed with TB. A total of 174 patients were enrolled in this study. The majority of patients' ages ranged from 5 to 17 years (111, 63.8%). Most of the patients were males (92, 52.9%) and (142, 81.6%) resided in Khartoum State. Lung opacity and hailer parenchymal shadows were the common presenting features (83, 47.7%) in chest X-ray. Sputum for acid fast bacilli was positive in only 20 (11.5%) patients. Testing for HIV was negative in 41 (23.6%) patients and was not done in 133 (76.4%). A total of 107 (61.5%) children were diagnosed as having pulmonary TB; extra pulmonary tuberculosis (EPTB) was 67 (38.5%). Tuberculous lymphadenitis was the commonest type of EPTB and was diagnosed in 38 (56.7%) patients. The majority 94 (87.9%) completed their treatment and 13 (12.1%) with smear positive results were cured. Defaulters were 20 (11.5%), and 6 patients (3.4%) were retreated after default, 11 (6.3%) were transferred out, and 14 (8%) are still on treatment. Thirteen patients (7.5%) died, and the outcome of three patients was not documented.
Prevalence of tuberculosis among children in North Sudan: Are we only seeing the tip of the iceberg?
Journal of natural science, biology, and medicine
Tuberculosis (TB) is a significant cause of morbidity and mortality among children. The vague symptoms, the uncertain diagnostic tests and lack of adequate awareness among families all contributed in masking the actual prevalence of the disease. The objective of this study was to describe the epidemiology of childhood TB in River Nile State (RNS), North Sudan. All registered cases of TB aged 15 years and below, at the 13 management units in RNS during 3 years, 2011-2013 were included. The records included epidemiological, clinical, and microbiological data. Out of the 1221 total TB notified cases, children were 187 (15.3%); almost equally distributed across the 3 years of the study period. Males were 56.7%. Most of the cases (89.9%) were newly diagnosed; among them, pulmonary TB (PTB) constituted 61.5%. Sputum specimen was tested in 59.4% (111/187) of cases, and only 15.3% (17/111) of specimens were sputum smear positive for new cases. The cure rate was (76.5%), and the treatment su...
PloS one, 2016
Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type ...
Journal of Tuberculosis Research
Background: Despite the fact that Tuberculosis (TB) is preventable, treatable and curable, it has remained a significant cause of childhood morbidity and mortality. Identifying patterns of TB and its treatment outcome which is the aim of this study is relevant for TB control programmes. Methodology: This was a retrospective cross-sectional study carried out over a three-month period from April-June 2019 at the directly observed treatment Short course (DOTS) clinic of the
Pediatric Health, Medicine and Therapeutics
Because of the pauci bacillary nature of childhood tuberculosis and the difficulties in obtaining proper sputum samples from young children, diagnosing childhood tuberculosis (TB) is difficult. Childhood TB needs early identification and care since it advances swiftly to more advanced stages. This study was aimed to determine the patterns of all forms of childhood tuberculosis diagnosis at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Methods: A retrospective cross-sectional study was conducted from February 1, 2017 to January 30, 2021 among 175 children diagnosed and treated for tuberculosis in the pediatric ward. Children medical charts and pediatrics ward logbook were used to extract pertinent data by structured checklists. SPSS version 23.0 was used for data entry and statistical analysis. Results: Of 175 children, fever was the leading clinical symptoms and diagnosed in 166 (94.9%) children followed by weight loss (154, 88%), and cough (136, 77.7%). In twenty seven out of 88 (30.6%) children, gastric aspirate was positive for TB infection by Xpert MTB/Rif, while 3/40 (7.5%) were positive for TB using fine needle aspiration cytology (FNAC), 19/66 (28.8%) had suggestive TB by cerebrospinal fluid analysis (CSF), 10/29 (34.5%) were smear positive for TB and 70/162 (43.2%) were suspected for TB by chest X-ray. Conclusion: Despite recent breakthroughs in quick microbiological detection, such as Xpert MTB/Rif, this study revealed that more than half of the children, 89/175 (51%), were treated for TB diseases solely based on clinical criteria. This will significantly underestimate the true nature of the illness or disease and make them vulnerable to mistreatment. As a result, in order to appropriately treat the disease and manage patients in our settings, getting a microbiological diagnosis of childhood tuberculosis requires improvement, and we call for expanded availability and use of a more sensitive and specific diagnostic technique to circumvent these concerns.
IAR-Medical Series, 2023
Background: Tuberculosis (TB) is still a problem because children are most likely to get severe forms and it is hard to tell who has it. The goal of this paper was to describe how TB showed up in children at a tertiary level hospital, how often it happened, how it was diagnosed, and how they responded to treatment. Methods: The study looked at cases of TB in children that showed up in different ways, both inside and outside of the lungs. Polymerase chain reaction (PCR) for M. tuberculosis nucleic acids, chest X-rays, and clinical assessment were all used to diagnose the disease. All people who might have TB were given antituberculosis treatment while they waited to find out for sure. In the intensive phase of treatment, people took four drugs, and in the support phase, they took two drugs (HR). In cases where the meninges were affected, steroids were given. There were follow-up assessments. Results: In this group of cases, the symptoms of pediatric tuberculosis (TB) were different and not typical. In Case 1, a 14-year-old boy was first wrongly diagnosed with celiac disease. Later, he was found to have constrictive pericarditis and TB, which shows how important it is to think about TB when someone has a fever for a long time and other strange symptoms. In Case 2, a 2-year-old girl with TB showed up with discolored skin and at first negative PCR results. This shows how hard it is to diagnose pediatric TB. Case 3 was about a 5-year-old boy who was having neurological problems and whose brain MRI showed multiple tuberculomas. This showed how serious neurological problems can be caused by pediatric TB. In Case 4, a 2-year-old boy with stroke-like symptoms and a fever responded well to anti-TB treatment, even though the initial PCR results were negative. This shows how important it is to treat pediatric TB as soon as possible, even when diagnostic tests aren't clear. Conclusions: Pediatric TB can show up in many different and unusual ways, which makes it hard to diagnose. PCR testing was a key part of making a diagnosis. Even though the diagnosis wasn't confirmed, these cases turned out well because antitubercular treatment was started quickly. This study shows how important it is to think about TB in children who have symptoms and a history that suggest it.
Paediatric Tuberculosis at a Referral Hospital in Istanbul: Analysis of 250 Cases
BioMed Research International, 2016
Background. Tuberculosis (TB) still remains a growing public health problem globally. TB in children is often diagnosed clinically. Methods. We conducted a retrospective chart review of children with TB from November 2004 through December 2010 to determine the appropriateness of using contact history and diagnostic testing. Results. A total of 250 children with TB were identified. One hundred and sixty-two children had only pulmonary disease while 39 had features of both extrapulmonary and pulmonary TB. Mean age was 7.8 years. Thirty-six patients had known contacts. The index case/cases were first-degree relatives in 75%. Sixteen patients who were symptomless were yielded by contact investigation of newly identified TB cases. Tuberculin skin test positivity was 53.3%. Acid-fast bacilli smear positivity was 13.1%, and culture positivity was 18.7%. Twenty-six patients had histopathology of nonrespiratory specimens (lymph nodes and other tissues) showing granulomatous inflammation and caseous necrosis consistent with TB. Conclusions. Presence of contact history directed us to search for TB in children with nonspecific symptoms even if physical examinations were normal. Some children who were close contacts to TB cases were identified to have TB before development of symptoms.
2024
Background: Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria. Methods: This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25. Results: A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis. Conclusion: Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.
Public Health Action, 2017
Objective: To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. Design: This was a retrospective comparative cohort study. Results: A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, P < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, P < 0.01) while transfers out were more common in the city (25% vs. 14%, P = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. Conclusion: This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.