Clinical presentation of tuberculosis in adolescents as seen at National Hospital Abuja, Nigeria

Abstract

Background: Adolescents with tuberculosis (TB) form a significant proportion of childhood TB cases presenting with specifics clinical patterns.Objective: To describe the clinical presentation of tuberculosis in adolescent at National Hospital Abuja (NHA), Nigeria.Subjects and method: This is a descriptive and retrospective study of adolescents aged 10- 15 years seen at the department of Paediatrics NHA Nigeria from August 2009 to July 2013.Result: Thirty- six adolescents diagnosed with tuberculosis were reviewed. Adolescent TB accounted for 18.8%(36/192) of total cases of children aged 0- 15years seen at the Department of Paediatrics Respiratory Clinic during the study period. The mean (SD) age was 12.3(1.76) years. Twenty seven patients (75.0%) were females and 9(25.0%) were males. Thirty (83.3%) were of lower socioeconomic class. History of contact with a case of TB was obtained in 17(47.2%). The commonest symptoms identified in these adolescents were; cough 27(75.0%), weight loss 22 (61.1%), fever18(50.0%), sputum 14(38.9%), body swelling 7(19.4%), hemoptysis 2(5.6%); while signs were underweight, pyrexia and chest findings. Nine (25.0%) had associated retroviral disease. Thirty four (94.4%) presented at time of diagnosis with clinical symptoms while 2(5.6%) were asymptomatic; identified during contact tracing as latent TB infection (LTBI). Abnormal chest radiograph findings were; widespread lung infiltrate in 10(27.8%), hilar opacities 7(19.4%), cavitatory lesions 4(11.1%), pleural Effusion 3(8.3%) and military opacities 1(2.7%). AFB was isolated in 5(13.9%), while 23(63.9%) had a raised ESR above 30mm/hr. Twenty seven (75.0%) of the adolescents completed treatment for tuberculosis, 7(19.4%) were lost to follow up and 2(5.6%) died while 4(11.1%) had re- treatment for TB from relapse. Clinical presentations were pulmonary TB (PTB) 22(61.1%), and extrapulmonary TB 12(33.3%); distributed as TB adenitis 4(11.1%), TBM 3(8.3%), Pericardial TB 3(8.3%), Miliary TB 1(2.8%) and Spinal TB 1(2.8). Of the nine with HIV- TB coinfection, the clinical presentation were; PTB 5(55.6%), and extrapulmonary 4(44.4%).Conclusion: The patterns of TB in adolescents are admixture as seen in younger children and adult from clinical and radiological characteristic findings. TB remains a preventable disease condition and is curable with early appropriate treatmentKey words: Adolescent tuberculosis, clinical pattern