Pediatrik pulmoner tüberküloz olgularının epidemiyolojik özellikleri ve tedavi sonuçları

Amaç: Pediatrik tüberküloz dünya çapında tüberküloz yükünün önemli bir kısmını oluşturmaktadır. Pediatrik tüberküloz toplumda tüberküloz yükünün devam ettiğini göstermesi bakımından da önemlidir. Çalışmamızda Adana ili Tüberküloz Dispanserlerine kayıtlı olan pediatrik pulmoner tüberküloz olgularının epidemiyolojik özelliklerini ve tedavi sonuçlarını incelemeyi amaçladık. Gereç ve Yöntemler: Pulmoner tüberküloz tanısı konan 0-18 yaş arası 56 çocuk demografik veriler, klinik özellikler, ilaç duyarlılık testi ve tedavi sonuçları açısından geriye dönük olarak incelenmiştir. Veriler tıbbi kayıtlardan elde edilmiştir. Bulgular: Yaş ortalaması 12,84 ± 5,62 olan olguların %46,4’ü kız idi. Sıfır-5 yaş arası 9 olgu (%16), 5-10 yaş arası 4 olgu (%7,1), 10-15 yaş arası 17 olgu (%30,3), 15-18 yaş arası 26 olgu (%46,4) vardı. Kırk sekiz çocukta sadece akciğer, sekizinde hem akciğer hem de akciğer dışı tutulum vardı. En sık görülen semptomlar uzun süren öksürük (%80,3) ve kilo kaybı (%73,2) idi. Sadece 22 hastaya ilaç duyarlılık testi uygulandı. Bir hastada çoklu ilaç direnci belirlendi. Tedavi sonuçları incelenen 56 çocuktan 39'u (%69,6) tedavisini tamamladı, 16'sında (%28,5) kür ve 1'inde (%1,7) tedavi başarısızlığı olduğu kaydedildi. Sonuç: Hastalarımızın belirti ve bulgularının literatür ile uyumlu olduğu gözlendi. Pediatrik pulmoner tüberküloz olgularının epidemiyolojik karakterizasyonu, bu populasyonda daha iyi bir tanı yaklaşımının elde edilmesine yardımcı olacaktır.

Epidemiologic features and treatment outcomes of pediatric pulmonary tuberculosis cases

Purpose: We here aimed to examine the epidemiologic features and treatment outcomes of pediatric pulmonary tuberculosis cases who were registered to the Adana Tuberculosis Dispensaries. Materials and Methods: Fifty-six pediatric patients aged 0-18 years with the diagnosis of pulmonary tuberculosis were examined retrospectively in terms of demographic data, clinical characteristics and drug susceptibility test results, as well as treatment outcomes. Data were collected through medical record review. Results: The mean age of the patients was 12.84 ± 5.62 years and 46.4% were female. Nine patients (16%) were aged 0-5 years, 4 (7.1%) were aged 5-10 years, 17 (30.3%) were aged 10-15 years and 26 patients (46.4%) were aged 15-18 years. Fourty-eight children was only pulmonary tuberculosis whereas eight possessed characteristics of both pulmonary and extrapulmonary tuberculosis. The most frequent symptoms were prolonged cough (80.3%) and weight loss (73.2%). Drug susceptibility test was performed only 22 patients. Multidrug resistance was determined in one patient. Among the 56 children for whom treatment outcome was documented, 39 (69.6%) were completed treatment, 16 (28.5%) were cured and 1 (1.7%) had treatment failure. Conclusion: It was observed that the signs and symptoms of our patients were compatible with the literature. The epidemiological characterization of pediatric patients with pulmonary tuberculosis helps to provide a better diagnostic approach in this population.

Keywords:

Mycobacterium tuberculosis, Pedaitrics Public health, Pulmonary tuberculosis,

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1. World Health Organization. Global Tuberculosis Report 2018. http://www.who.int/tb/publications/global_report /en/ (date of access 2020 May 01).
2. Ohene SA, Fordah S, Boni PD. Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis. BMC Infect Dis. 2019;19:6-9.
3. Keshtkar Jahromi M, Sharifi-Mood B. Pulmonary tuberculosis in children. Int J Infect. 2014;1(3):e21116. http://intjinfection.com/articles/14737.html.
4. Turel O, Kazanci S, Gonen I, Aydogmus C, Karaoglan E, Siraneci R. Paediatric tuberculosis at a referral hospital in Istanbul: Analysis of 250 cases. Biomed Res Int. 2016;2016:1-6.
5. Dilen MF, Çelik T, Tolunay O, Çelik U. Clinical features in childhood tuberculosis followed in our clinic. J Pediatr Inf. 2018;12(4):e129-e34.
6. Gencer H, Dalgıç N, Kafadar I, Kabakçı D, Öncül U. Retrospective evaluation of 35 pediatric tuberculosis cases proven by histopathological and/or microbiological analysis. J Pediatr Inf. 2015;9:97-101.
7. Yunda LF, Sepúlveda EV, Herrera KC, Moreno C. Pulmonary tuberculosis in a pediatric reference hospital in Bogota, Colombia. Int J Mycobacteriol. 2017;6:258-63.
8. Gulec SG, Telhan L, Koçkaya T, Erdem E, Bayraktar B, Palanduz A. Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey. Yonsei Med J. 2012;53:1176-82.
9. Bayhan GI, Tanır G, Metin O, Şimsek H, Aydın-Teke T, Öz FN et al. Pediatric tuberculosis in Turkey: a review of 8-years period in a tertiary care hospital. Turk J Pediatr. 2015;57:431-38.
10. Kamer I, Sütçü M, Acar M, Erol OB, Hançerli Törün S, Salman N et al. Pediyatrik tüberküloz: Bir üniversite hastanesinin beş yıllık deneyimi. J Child. 2017;17:43-9.
11. Ian Kitai MB BCh, Shaun K Morris MD MPH, Faisal Kordy MD, Ray Lam MN-ANP PHCNP. Diagnosis and management of pediatric tuberculosis in Canada. CMAJ. 2017; 9,189: E11-6. doi: 10.1503/cmaj.151212.
12. Babalık A, Kılıçaslan Z, Kızıltaş Ş, Gencer S, Öngen G. Aretrospektif case-control study, factors affecting treatment outcomes for pulmonary tuberculosis in Istanbul, Turkey. Balkan Med J. 2013;30:204-10.
13. Harausz EP, Garcia-Prats AJ, Law S, Schaaf HS, Kredo T, Seddon JA et al. Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta- analysis. PLoS Med. 2018;15(7):e1002591.
14. Biruk M, Yimam B, Abrha H, Biruk S, Amdie FZ. Treatment outcomes of tuberculosis and associated factors in an Ethiopian university hospital. Adv Public Health. 2016;2016:1-9.
15. Guidance for national tuberculosis programmes on the management of tuberculosis in children. World Health Organization. 2nd Ed. ISBN 978 92 4 154874 8. https://www.who.int/tb/publications/childtb_guide lines/en/(date of access: 2020 May 19).
16. Tanır G, Akın A, Aydemir C, Üner Ç, Ceyhan İ. The diagnosis of definitive or probable tuberculosis and latent tuberculosis infection in children with suspected tuberculosis. Tuberk Toraks. 2005;53:259- 64.
17. Bayhan Gİ, Ekşioğlu AS, Kitiş Çelik B, Tanır G. Pulmonary tuberculosis in infants less than one year old: Implications for early diagnosis. Tuberk and Toraks. 2011;59:36-42.
18. Gupta N, Kashyap B, Dewan P, Hyanki P, Singh NP. Clinical spectrum of pediatric tuberculosis: A microbiological correlation from a tertiary care center. J Trop Pediatr. 2019;65:130-38.
19. Berti E, Galli L, Venturini E, Martini De M, Chiappini E. Tuberculosis in childhood: a systematic review of national and international guidelines. BMC Infect Dis. 2014;14:S3.
20. Cano APG, Romaneli MTN, Pereira RM, Tresoldi AT. Tuberculosis in pediatric patients: How has the diagnosis been made? Rev Paul Pediatr. 2017;35:165- 70.
21. Cruz AT, Starke JR. Pediatric tuberculosis. Pediatr Rev. 2010;31:13-25.