Association of Tuberculosis With Severe Acute Malnutrition

Abstract

BACKGROUND: India houses highest number of malnourished children next to African countries. Malnutrition is lethal in combination with Tuberculosis. Efficacy of BCG vaccination, a part of Universal Immunization Programme in preventing TB infection and utility of TST in detection of TB infection in malnourished children needs to be studied. OBJECTIVE: 1. To obtain the morbidity pattern of tuberculosis. 2. To study the role of BCG vaccination and reliability of TST in under five children with severe acute malnutrition. MATERIAL AND METHODS: DESIGN: A prospective study. SETTING: Severe malnutrition unit in a tertiary level referral hospital in central India. PARTICIPANTS: Under five children with severe acute malnutrition in SMTU. OUTCOME MEASURES: 1. Presence of tuberculosis in SAM children. 2. Morbidity pattern of tuberculosis in SAM children. 3. Presence of BCG scar in diseased children. 4. Reactivity status of TST in diseased children. RESULTS: Tuberculosis was diagnosed in 22% of severe acute malnutrition cases. Seventy eight percent (78.50%) of the pulmonary tuberculosis cases were younger than 1 year. In children of 13-26 months of age, 50% of cases were pulmonary tuberculosis while neuro-tuberculosis and disseminated tuberculosis contributed 25% each. BCG scar was present in 86.6% of malnourished children with pulmonary tuberculosis while only 28.4% of extra pulmonary seriously ill cases had BCG scar. Positive tuberculin reaction was seen in only 8.0% children, 50% of them had 10-15mm induration. CONCLUSION: Tuberculosis is one of the treatable causes of malnutrition and there is high prevalence of tuberculosis infection among SAM children. Identifying adult cases and giving proper treatment as well as screening their malnourished children will help in early identification and preventing spread of pulmonary TB among children.

Incidence of tuberculosis and its predictors among under-five children with severe acute malnutrition in North Shoa, Amhara region, Ethiopia: a retrospective follow-up study

“…A data collection tool was prepared from the national treatment protocol for the management of SAM (18), SAM registration booklet, health management information system (HMIS) register, SAM multi-chart, TB guideline (19) and by reviewing articles (10,(20)(21)(22). The checklist used consisted of sociodemographic data (age, sex, residence, history of TB contact), anthropometric measurements (height, Mid Upper Arm Circumference (MUAC), weight, edema), comorbidities, feeding phase and types of feeding (F75, F100), frequency of feeding and amount per feed, immunization status, admission and discharge date, referral address as well as medication given and outcomes of the treatment.…”

“…TB causes loss of appetite, cachexia and wasting and may be impacted by poor nutritional status (20,21). It also leads to worse nutrition and suppresses immunity undernutrition, thereby increasing the probability that latent TB will develop into an active disease (22)(23)(24). In addition, 3-fold also increases the risk of acquiring TB among malnourished children, which could predispose the community to progress to TB in high TB-burden settings, including Ethiopia (24)(25)(26).…”

Hubungan Asupan Energi, Asupan Protein dan Status Gizi terhadap Kejadian Tuberkulosis pada Anak

“…terdapat beberapa faktor yang mempengaruhi seseorang terjangkit tuberkulosis meliputi karakteristik individu, tingkat pajanan dan lingkungan rumah (6). Adapun faktor risiko sosial ekonomi seperti kemiskinan, buta huruf, ketidaktahuan, kepadatan penduduk dan sanitasi yang buruk juga memainkan peran penting dalam tuberkulosis (17). Faktor yang menjadi kata kunci pada pembahasan ini adalah asupan dan status gizi, dimana apabila anak yang mengalami kekurangan asupan zat gizi otomatis akan mengalami malnutrisi, sehingga kondisi tersebut lebih beresiko terkena infeksi tuberkulosis dibandingkan dengan anak yang terpenuhi asupan zat gizinya.…”

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

“…Combination of malnutrition and tuberculosis is very lethal. 2 In India, more than 33% of under-five deaths were associated with malnutrition. 3 SAM affects both acquired and innate host defense mechanisms.…”