Childhood Tuberculosis in Northern Viet Nam: A Review of 103 Cases

Abstract

BackgroundChildhood tuberculosis causes significant morbidity and mortality in Southeast Asia, yet little is known about the epidemiology and clinical characteristics of this disease in Viet Nam.ObjectivesTo determine the demographics, clinical presentations, radiographic and microbiologic findings, treatment regimens, and outcomes of children admitted with tuberculosis (TB) to a national referral hospital in Viet Nam.MethodsWe conducted a retrospective case series study of children ≤ 15 years old with bacteriologically confirmed or clinically diagnosed TB admitted to a national referral hospital in Ha Noi, Viet Nam from January through December 2007.ResultsOne hundred three children were identified: median age 5 years (IQR 2-10), 44% female, 99% Kinh ethnicity, 27% residing in Ha Noi, 88% with BCG vaccination, 27% with known TB contact, and 38% malnourished. Intrathoracic TB was present in 62%, extrathoracic in 52%, both intra and extrathoracic in 19%, and undetermined site in 5%. The most common extrathoracic manifestation was peripheral lymphadenitis, and children under 5 were more likely to have miliary TB or both intra and extrathoracic TB. Fever and failure to thrive were common presenting symptoms among all participants (65% and 56%, respectively), 66% of those with intrathoracic TB presented with cough, and 92% of those with TB meningitis presented with severe neurologic impairment. Acid-fast bacilli smears and mycobacterial cultures were positive in 18% and 21% of children tested, and histopathology was positive in 88% of those biopsied. There were no adverse drug reactions necessitating change in therapy, and no inpatient mortality.ConclusionsExtrathoracic TB was common, treatment well tolerated and clinical outcomes excellent. Culture confirmation rates were low and emphasize the need for improved diagnostics.

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

“…In an individual patient data meta-analysis of over 100 000 children from all over the world, including Peru, Routine registers from primary care clinics do not include recording of paediatric contacts diagnosed with TB in referral hospitals. Furthermore, ruling out TB in young children, especially in those <2 years oldthe age group at highest risk of developing TB after exposure [12,13] involves recognition of warning signs and symptoms by parents and physicians, including the revision of growth charts [10,14] These are not routinely recorded in TB contact investigation, hampering follow-up. Training primary care staff on paediatric TB screening and diagnosis, strengthening communication between referral and primary care facilities, and designing forms to facilitate the appropriate recording and follow-up of contacts may increase TB detection in and provision of preventive treatment to eligible contacts [15][16][17][18][19] Our study has several limitations.…”

Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

“…In line with this study, other studies have shown that males are often at a higher risk of Tuberculosis and also more likely to die from TB especially in the older age groups. [11][12][13] Mayank et al [12] in India reported a male: female ratio of 1.8:1 among children less than 8years. Also, Blount et al reported a higher male prevalence among males in a Vietnam study [13].…”

“…[11][12][13] Mayank et al [12] in India reported a male: female ratio of 1.8:1 among children less than 8years. Also, Blount et al reported a higher male prevalence among males in a Vietnam study [13]. However, the genetic risk in males for TB is yet to be elucidated.…”

Child pneumonia – focus on the Western Pacific Region

“…This is well below the estimated global average of 10%. Of 103 children (<15 years) diagnosed with tuberculosis in Northern Viet Nam, most were in the 5-14 year age range [54], suggesting gross under-detection in young children who are known to be most vulnerable [55]. Following a successful proof-ofconcept study in 4 provinces [48], the Viet Nam National Tuberculosis Control Program plans to expand community-based contact screening and provision of preventive therapy to all provinces by 2020.…”