Clinical Presentations and Outcomes Related to Tuberculosis in Children Younger Than 2 Years of Age in Catalonia

Frontiers in Pediatrics

article

Antoni Soriano-Arandes¹  Maite Coll-Sibina²  Luis Mayol³  Asumpció Clopés⁴  Valentí Pineda⁵  Lourdes García⁶  Nuria López⁷  Olga Calavia⁸  Neus Rius⁹  Tomas M. Pérez-Porcuna^1,10  Pere Soler-Palacín¹  Silvia Brugueras^1,11  Joan A. Caylà^1,14  Alejandro Rodríguez Chitiva¹  Antoni Noguera-Julian^1,12  Àngels Orcau^1,11  Andrea Martín-Nalda¹  Joan P. Millet^1,11  Teresa Vallmanya^1,18  Maria Méndez^1,19 

[1] Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron;Hospital General de Granollers;Hospital Universitari Josep Trueta;Hospital Pius;Hospital Universitari Parc Taulí;Pediatrics, Consorci Sanitari del Maresme;Hospital Universitari del Mar;Hospital Universitari Joan XXIII;Hospital Universitari Sant Joan de Reus;Unitat clínica de Tuberculosi i Salut Internacional, Hospital Universitari Mútua de Terrassa;Servei Epidemiologia, Agència de Salut Pública de Barcelona;Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP);Universitat Autònoma de Barcelona;Foundation of TB Research Unit of Barcelona;Hospital Universitari Sant Joan de Déu;Universitat de Barcelona;Red de Investigación Translacional en Infectología Pediátrica;Hospital Universitari Arnau de Vilanova;Hospital Universitari Germans Trias i Pujol

关键词: tuberculosis;    infants;    low-incidence country;    complications;    sequelae;    risk factors;   

DOI  :  10.3389/fped.2019.00238

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction: Children younger than 2 years have an increased risk of complications associated with tuberculosis (TB) due to the immaturity of the innate and adaptive immune response. We aimed to identify TB clinical presentations and outcomes as well as risk factors for complications in this age group. Materials and Methods: Multicenter, retrospective, cross-sectional study of TB cases in children aged <2 years in Catalonia (2005–2013). Epidemiological and clinical data were collected from the hospital medical records. TB complications, sequelae included, were defined as any tissue damage generating functional or anatomical impairment after being diagnosed or after TB treatment being completed. Statistical analyses were based on bivariate chi-square and multivariate logistic regression, and it was carried out with Stata® version 13.1. Odds ratios (OR) and its 95% confidence intervals were calculated (CI). Results: A total of 134 patients were included, 50.7% were male, the median [IQR] age was 13[8-18] months, and 18.7% (25/134) showed TB-associated complications. Pulmonary TB was diagnosed in 94.0% (126/134) of children, and the most common complications were lobar collapse (6/126). TB meningitis was diagnosed in 14/134 (10.4%), and hydrocephalus and mental impairment occurred in 1 and 2 patients, respectively. Two patients with spinal TB developed vertebral destruction and paraplegia, respectively. Only one of the patients died. At multivariate level, tachypnea (OR = 4.24; 95% CI 1.17–15.35) and meningeal (OR = 52.21; 95% CI 10.05–271.2) or combined/extrapulmonary forms (OR = 11.3; 95% CI 2.85–45.1) were associated with the development of TB complications. Discussion: TB complications are common in children under 2 years old. Extrapulmonary TB forms in this pediatric age remain a challenge and require prompt diagnosis and treatment in order to prevent them. The presence of tachypnea at the time of TB diagnosis is an independent associated factor to the development of TB complications in infants. This clinical sign should be closely monitored in patients in this age group. It is necessary to perform further studies in this age group in a prospective design in order to understand whether there are other factors associated to TB complications.

【 授权许可】

CC BY