Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children
Open Access
- 13 July 2022
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Pediatric Infectious Disease Journal
- Vol. 41 (8), 620-625
- https://doi.org/10.1097/inf.0000000000003584
Abstract
Background: Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan. Methods: In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years. Results: A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB. Conclusions: This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.Keywords
This publication has 15 references indexed in Scilit:
- Evaluation of Clinical and Laboratory Characteristics of Children with Pulmonary and Extrapulmonary TuberculosisMedicina, 2019
- Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional studyBMC Public Health, 2019
- Common alternative diagnoses among a pediatric hospital-based cohort evaluated for tuberculosis in Karachi, Pakistan: The need for facilitated referral in tuberculosis clinicsInternational Journal of Mycobacteriology, 2019
- Improving childhood tuberculosis detection and treatment through facility-based screening in rural PakistanThe International Journal of Tuberculosis and Lung Disease, 2018
- Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective studyPeerJ, 2018
- Pediatric Extrapulmonary TuberculosisThe Pediatric Infectious Disease Journal, 2016
- Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from NigeriaInternational Journal of Mycobacteriology, 2016
- Counting children with tuberculosis: why numbers matterThe International Journal of Tuberculosis and Lung Disease, 2015
- Host and Microbial Predictors of Childhood Extrathoracic Tuberculosis and Tuberculosis MeningitisThe Pediatric Infectious Disease Journal, 2015
- Tuberculous Lymphadenitis as a Cause of Persistent Cervical Lymphadenopathy in Children From a Tuberculosis-Endemic AreaThe Pediatric Infectious Disease Journal, 2006