Pneumonia, Severe acute malnutrition, Tuberculosis, Xpert MTB/RIF assay
Citation Information :
S S, Ratageri VH, Shivananda I, C S, Wari P. Pulmonary Tuberculosis in Children with Severe Acute Malnutrition: A Prospective Hospital-based Study. Pediatr Inf Dis 2019; 1 (1):1-3.
Background: Tuberculosis is one of the common infectious diseases in under-five children especially with severe acute malnutrition (SAM). Pulmonary tuberculosis (PTB) presenting as pneumonia in undernourished children especially in communities where TB is highly endemic is still a less recognized entity.
Objective: To study the prevalence of pulmonary tuberculosis in severe acute malnourished children with acute pneumonia.
Materials and methods: Prospective hospital-based observational study done at Nutritional Rehabilitation Centre (NRC), Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India from January 2016 to December 2016.
Inclusion criteria: Severe acute malnourished children of 1 month to 59 months of age with acute pneumonia with/without HIV infection.
Exclusion criteria: Children with severe acute malnutrition already diagnosed to have any form of tuberculosis and on ATT. All enrolled children\'s detailed history and examination was taken in a predesigned Proforma. A detailed history, examination and investigations like complete hemogram, Mantoux test, chest X-ray, gastric lavage for AFB, Xpert MTB/RIF, was done in all enrolled children.
Results: Total of 152 SAM children admitted during the study period, of these 29 (19.07%) fulfilled inclusion/exclusion criteria, with a mean age of 14.29 ± 9.63 months and male (14) to female (15) ratio of 0.9:1. The prevalence of pulmonary tuberculosis in SAM with acute pneumonia was 10.34% (3/29). All three were males, 2 cases were ≤12 months. Clinical symptoms/signs in order of frequency were fever (100%), respiratory distress (100%) and cough (66.66%). Risk factors for the development of tuberculosis were (i) presence of contact history (2/3) (p = 0.007) and (ii) positive Mantoux test (2/3) (p = 0.02), respectively. Though tuberculosis was more in children with absent BCG scar however it was statistically not significant (2/3). All three were bacteriologically confirmed (Xpert MTB/RIF assay) and rifampicin sensitive. Smear for AFB was positive in only one child.
Conclusion: Pulmonary tuberculosis should be considered in SAM children with acute pneumonia. Family history of contact with tuberculosis and positive Mantoux test was significant risk factors. XpertMTB/RIF was found superior in isolating TB bacilli as compared to smear for AFB
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