This Cross-sectional observational study was conducted to determine the clinical profile of drug-resistant tuberculosis in children. Patients were classified as monoresistant TB, polyresistant TB, multidrug resistant (MDR)-TB and extensively drug resistant (XDR - TB). We coined a term called as Partial XDR-TB when isolates of Mycobacterium tuberculosis were confirmed to be resistant in vitro to be MDR along with either a fluoroquinolone or an aminoglycoside resistance (apart from streptomycin). Of 500 children analysed, 34 (6.8%) had drug resistant TB. Mean age of presentation was 6.8 ± 3.2 years (Male: Female ratio 13:21). 18 (52.9%) children had been treated for tuberculosis in the past (1 defaulted), 7 patients had been in contact with an adult suffering from drug resistant TB and 3 patients (10.3%) were HIV co-infected. Fourteen children (41.2%) had MDR TB, 11 (32.4%) had Partial XDR, 1 each (2.9%) had polyresistant TB and XDR TB. Clinical features of DR-TB are similar in all age groups. Past history of TB with treatment with antitubercular agents, and contact with adults suffering with drug-resistant TB are important risk factors in development of drug-resistant -TB in children.

Objective: To study the clinical profile of pulmonary TB in children at various ages. Methods: Forty-five children with pulmonary TB who were referred over a period of 12 months were included in the study. Clinical profile of various types of pulmonary TB and factors associated with them were compared. Results: Mean age of presentation was 5.4 AE 3.7 years. Male:female ratio was 32:13. Common clinical features were fever in 36 (80%), cough in 30 (66.7%), loss of appetite and malnutrition in 18 (40%) patients each. Raised ESR was seen in 28 out of 35 (80%) patients. Forty-two (93.3%) children had received BCG vaccination and 22 out of 37 (59.5%) were tuberculin skin test (TST) positive. Primary complex was seen in 22 (48.9%) patients, primary progressive TB in 17 (37.8%) and cavitatory TB in 4 (8.9%) patients. Anemia (p ¼ 0.006) and thrombocytosis (p ¼ 0.024) was in patients with cavitatory lesions. Children 5 years had primary complex followed by primary progressive and then by cavitatory lesion (Odd's ratio: between primary complex vs primary progressive ¼ 1.56; primary complex vs cavitatory ¼ 15.35; primary progressive vs cavitatory ¼ 10.06). In children >5 years of age, it was found that cavitatory lesions was more commonly seen followed by primary progressive and then by primary complex (Odd's ratio between cavitatory and primary progressive ¼ 10.06; cavitatory vs primary complex ¼ 15.35; primary progressive vs primary complex ¼ 1.56). Conclusion: Primary complex is the commonest presentation of pulmonary TB. Primary complex is seen more commonly in children <5 years of age while cavitatory lesions are more commonly seen in children >5 years of age.

Paradoxical reaction during antituberculosis treatment (ATT) is commonly seen as tuberculous lymphadenitis of peripheral lymph node, cerebral tuberculomas, pulmonary infiltrates, and pleural disease. This phenomenon is more commonly associated with extrapulmonary tuberculosis and disseminated tuberculosis. Respiratory distress, as presentation of paradoxical reaction, is rare. We report an 8-month-old child with primary progressive tuberculosis without mediastinal adenopathy, who developed paradoxical reaction with extensive mediastinal adenopathy within 15 days of ATT and presented with severe respiratory distress. The child responded to short course of high-dose steroids.

Congenital cystic adenomatoid malformation (CCAM) is a rare, developmental, hamartomatous abnormality of the lung characterized by a cessation of normal bronchiolar maturation, resulting in cystic overgrowth of the terminal bronchioles. We report one such case of CCAM in a 5-month-old female infant who was in perfect health until she suffered from spontaneous pyopneumothorax with type III CCAM of the lung and recovered after lobectomy.

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