Study of Clinico-Radiological Parameters in Diagnosis of Pediatric Tuberculosis at Tertiary Care Hospital

Abstract

Background: Global TB burden in India in children is about 2.2 lakh per year, among which pulmonary TB is most common presentation. Childhood TB contributes to about 10-20% of all TB in high burden countries and accounting for 8-20% TB related deaths. Children up to 14 years constitute about 35% of the population in our country and are expected to contribute about 10% of the case load. In order to achieve ‘Zero death by TB’, additional focus has to be directed towards TB in children. Paediatric clinical feature is variable in tuberculosis. Many cases of primary TB infection in children are asymptomatic and remain completely unnoticed or accidentally discovered at a later stage. In this study we looked for clinical and radiological presentation of childhood TB and its correlation in diagnosis within a period of 1 year in a tertiary care hospital. Methods: Total 254 children suspected of having tuberculosis were enrolled in the study and various microbiological, laboratory and radiological tests were used to diagnose the patients. Clinical samples were processed using standardized protocols. CBNAAT was the initial test of choice for microbiological confirmation. Results: Among 254 children, 69(27%) had pulmonary tuberculosis, extrapulmonary tuberculosis was found in 76(30%) children. Fever was the most common (in 100% cases) symptom in pulmonary TB. Most common radiological presentation was segmental consolidation (44%). Amongst 69 pulmonary TB patients, 16(23%) were Rifampicin resistant by CBNAAT method. Conclusion: Primary childhood TB being paucibacillary, makes microbiological diagnosis (gold standard) difficult. In relevant clinical setting, certain radiological lesions may be highly suggestive of tuberculosis: miliary pattern, hilar and/or paratracheal lymphadenopathy with or without parenchymal involvement and fibro-cavitatory lesions. All presumptive TB cases with these radiological patterns are considered to be probable TB and should be subjected to microbiological testing to confirm the diagnosis.