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Complications common in Spanish children with extrapulmonary TB
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Recent findings from a Spanish study showed that immigrant status, immune disorders and drug resistance were linked to pediatric extrapulmonary tuberculosis, with 40% of patients presenting with complications.
“Our study describes the epidemiology, clinical spectrum and diagnostic challenges of pediatric [extrapulmonary tuberculosis (EPTB)] in a low-burden region,” Begoña Santiago, PhD, at Hospital General Universitario Gergorio Marañón in Madrid, and colleagues wrote. “Few reports have specifically addressed pediatric EPTB, and this represents the largest series from a low-burden region over the last decades.”
Children aged younger than 15 years accounted for 6.5% of all global TB cases, the researchers wrote. However, they said, children have a greater risk for EPTB, in which TB affects organs other than the lungs, pleura or intrathoracic lymph nodes. Because of the low sensitivity of testing for younger age groups, the global impact of pediatric EPTB remains unclear.
To determine the clinical profile of EPTB in these groups, the researchers performed a retrospective analysis of children aged younger than 18 years diagnosed with TB (n = 526) in the Madrid region from January 2005 to June 2013. They compared epidemiology, clinical characteristics and diagnostic testing for EPTB and pulmonary TB. Multivariate logistic regression was used to identify risk factors associated with EPTB.
Almost 18% of pediatric TB cases were EPTB, Santiago and colleagues reported, with the most common being lymphatic TB (34.5%). The source case was identified in 28% of EPTB cases, compared with 63.3% of pulmonary TB cases (P < .001). The tuberculin skin test induration (< 5 mm) was smaller in EPTB cases (21.8% vs. 4.8%; P < .001), while the IGRA sensitivity was comparable (76.9% vs. 79.4%). EPTB children had a higher rate of bacteriologic confirmation (66.7% vs. 49.4%; P ≤ .01) and a greater incidence of multidrug-resistant TB (8.2% vs. 1.6%; P = .03). Complications were observed in 40.2% of EPTB cases, and EPTB was associated with immune disorders (OR = 5.8; 95% CI, 1.9-17.1), drug resistance (OR = 2.4; 95% CI, 1.1-5.4) and being born outside of Spain (OR = 2.37; 95% CI, 1.1-5.3).
“Our study emphasizes the contribution of EPTB on pediatric TB-associated morbidity and lifelong disabilities, even in regions with optimal resources,” Santiago and colleagues wrote. “Our study underscores the relevance of improved diagnostic tools and systematic TB screening in high-risk populations.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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