Pediatric Infectious Disease

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VOLUME 1 , ISSUE 1 ( January-March, 2019 ) > List of Articles

Original Article

Pulmonary Tuberculosis in Children with Severe Acute Malnutrition: A Prospective Hospital-based Study

Shruthi S, Vinod H Ratageri, Illalu Shivananda, Shilpa C, PK Wari

Keywords : 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.

DOI: 10.5005/jp-journals-10081-1101

License: CC BY-NC 4.0

Published Online: 01-10-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

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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  1. Global Tuberculosis Report 2018: Geneva: WHO status report. Available at http://apps.who.int/iris.
  2. Sathenahalli VB, Minarey N, Gornale V, et al. Association Of Tuberculosis With Severe Acute Malnutrition. J of Evolution of Med and Dent Sci 2015;4(68):11865-11870.
  3. World Health Organization, Country Office For India; National Rural Health Mission(IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual.(New Dehli): World Health Organization, Country Office for India; 2011.
  4. Alem A, Alemseged A, Getenet B, et al. Bacteremia among severely malnourished children in Jimma university hospital, Ethiopia. Ethiop J Health Sci 2011;21(3):175-182.
  5. Bhat PG, Kumar AMV, Naik B, et al. Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed opportunities. PLOS ONE 2013;8(12):e84255.
  6. Chisti MJ, Tebruegge M, Vincente SL, et al. Pneumonia in severely malnourished children in developing countries–mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health 2009;14(10):1173-1189.
  7. Gupta KB, Gupta R, Atreja A, et al. Tuberculosis and nutrition. Lung India 2009;26(1):9-16.
  8. Adegbola RA, Obaro SK. Diagnosis of childhood pneumonia in the tropics. Ann Trop Med Parasitol 2000;94(3):197-207.
  9. Chisti MJ, Graham SM, Duke T, et al. A Prospective Study of the Prevalence of Tuberculosis and Bacteraemia in Bangladeshi Children with Severe Malnutrition and Pneumonia Including an Evaluation of Xpert MTB/RIF Assay. PLoS ONE 2014;9(4):e93776.
  10. Chisti MJ, Ahmed T, Pietroni MAC, Faruque ASG, Ashraf H, Bardhan PK, et al. Pulmonary tuberculosis in severely-malnourished or HIVinfected children with pneumonia: A Review. J Health Popul Nutr 2013;31(3):308-313.
  11. Jaganath D, Mupere E. Childhood tuberculosis and malnutrition. J Infect Dis 2012;206:1809-1815.
  12. Global Tuberculosis Report 2013. World Health Organisation, Geneva; 2013.
  13. McNally LM, Jeena PM, Gajee K, et al. Effect of age, polymicrobial disease, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study. The Lancet 2007;369(9571):1440-1451.
  14. Punia RS, Mundi I, Mohan H, et al. Tuberculosis prevalence at autopsy: a study from North India. Trop Doct 2012;42(1): 46-47.
  15. Nantongo JM, Wobudeya E, Mupere E, et al. High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda. BMC Pediatr 2013;13(16):2-8.
  16. Bates M, Mudenda V, Mwaba P, et al. Deaths due to respiratory tract infections in Africa: a review of autopsy studies. Curr Opin Pulm Med 2013;19(3):229-237.
  17. “Childhood TB: Training Toolkit”, WHO, Geneva, 2014 www.who.int/tb/challenges/childtbtraining_manual/en/. Accessed on 29th October 2016.
  18. Seth V, Kabra SK. Pulmonary Tuberculosis. In: Vimlesh Seth, S K Kabra. Essentials of Tuberculosis in Children. 4th edition. Jaypee Brothers Medical Publishers; 2011. Chapter 9. p101-121.
  19. National Guidelines on Diagnosis and Treatment of Pediatric Tuberculosis. 2012. Available from: http://www.tbcindia.nic.in/Paediatricguidelines_New.pdf.
  20. WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva, World Health Organization; 2013 https://www.who.int/elena/titlesfull_recommendations/sam_management/en/
  21. Revised WHO classif ication and treatment of childhood pneumonia at health care faciliti.apps.who.int/irisbitstream/10665/137319/1/9789241507813_eng.pdf
  22. Chisti MJ, Ahmed T, Faruque ASG, et al. Clinical and laboratory features of radiologic pneumonia in severely malnourished infants attending an urban diarrhea treatment center in Bangladesh. Pediatr Infect Dis J 2010;29(2):174-177.
  23. Kumar R, Singh J, Joshi K, et al. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition. Indian Pediatr 2014;51:125-127.
  24. De Maayer T, Saloojee H. Clinical outcomes of severe malnutrition in a high tuberculosis and HIV setting. Arch Dis Child 2011;96(6):560-564.
  25. Sarvi F, Momenian S, Khodadost M, et al. The examination of relationship between socioeconomic factors and number of tuberculosis using quantile regression model for count data in Iran. Med J Islam Repub Iran 2016;30(399):1-7.
  26. Pathak R R, Mishra BK, Moonan PK, et al. Can Intensified Tuberculosis Case Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?. J Tuberc Res 2016;4(1):46-54.
  27. Chisti MJ, Salam MA, Ashraf H, et al. Histiry of Contact with Active TB and Positive Tuberculin Skin Test Still Work as the Best Predictors in Diagnosing Pulmonary TB among Severely Malnourished Pneumonia Children. J Mycobac Dis 2014; 4(3):1-5.
  28. WHO | Xpert MTB/RIF: WHO Policy update and Implementation manualhttps://www.who.int/tb/laboratory/xpert_launchupdate/en/
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