Clinical manifestations and diagnosis of extrapulmonary tuberculosis in children

Abstract

Objective: Tuberculosis (TB) is an important public health problem both in developing and developed countries due to migration with increasing incidence despite control strategies. Various clinical manifestations of extrapulmonary tuberculosis (EPTB) cause delay in diagnosis and treatment. In the present study, we aimed to evaluate the clinical and laboratory findings of extrapulmonary tuberculosis in childhood. Material and Methods: The medical records of patients hospitalized with the diagnosis of EPTB in the pediatric infection disease department between December 2007 and December 2017 were evaluated retrospectively. Results: There were 90 patients diagnosed with EPTB with fifty-six (62.2%) female and 34 (37.8%) male patients. Age distributions ranged from 3 to 204 months and mean patient age was 123.2 ± 63.5 months. Twenty-nine (32.2%) patients had TB lymphadenitis, 14 (15.6%) had gastrointestinal TB, 12 (13.3%) had TB meningitis, 12 (13.3%) had miliary TB, 10 (11.1%) had pleural TB, and 6 (6.7%) patients had bone TB. Out of 7 patients (7.7%), three had renal, two had skin and the other two had genitourinary and pericarditis involvement. Nineteen patients had (21.1%) concomitant pulmonary involvement. Forty-one (45.6%) patients had history of TB contact. Forty-eight (53.3%) families received minimum wage. Eighty-seven (96.7%) patients had BCG vaccine, and the weight of 37 (41.1%) patients was below the third percentile. Forty-four (48.9%) patients had tuberculine skin test and 31 (34.4%) patients had interferon gamma release test positivity. Acid resistant bacteria was demonstrated in 29 (32.2%) of the body fluid samples and culture positivity was demonstrated in 28 (31.1%) samples. Histopathological findings were confirmed in 46 (51.1%) patients. When the patients with EPTB were subgrouped according to localisations, ages of the patients with pleu- ral TB were older (p= 0.005). Miliary TB was higher in families receiving minimum wage and in families with a history of TB contact (p= 0.000, p= 0.020 respectively). Miliary TB was more common in patients with body weights below the third percentile (p= 0.003). TDT positivity was higher in TB lymphadenitis (p= 0.010). Histopathologic findings were strongly positive in gastrointestinal TB (p= 0.000). Conclusion: TB is an infectious disease that involves mostly the lymph nodes other than the lung. Although histopathologic and microbiologic evaluations are important in the diagnosis of EPTB, TB should be kept in mind in patients admitted with different complaints and signs in places with high TB incidence like our country.