A profile of bacteriologically confirmed pulmonary tuberculosis in children.

OBJECTIVE: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. STUDY DESIGN: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. RESULTS: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. CONCLUSIONS: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area.

Prevalence study of tuberculous infection over fifteen years, in a rural population in Chingleput district (south India).

As in the earlier BCG trial against tuberculosis conducted in Chingleput district in south India (in 1969), the entire study population was tuberculin tested (Survey I), a study was undertaken subsequently to see whether in this population there was any change in the tuberculosis situation in terms of prevalence of infection in children. For this purpose, in two of the panchayat unions, in a random sample of panchayats, tuberculin testing was repeated twice at an interval of 10 yr (Survey II) and 15 yr (Survey III) after the initial testing in children aged 1-9 yr. High coverages were obtained for tuberculin testing and reading. Data from 8,703 and 9,709 children at Surveys I and II respectively was used for comparing the prevalence of infection over a period of 10 yr and from 4,808, 4,965 and 4,889 children at Surveys I, II and III respectively for comparing the prevalence of infection over a period of 15 yr. The results showed that although the prevalence of infection varied in the two panchayat unions, within each panchayat union it did not differ significantly at the three surveys. The overall prevalence of infection at the three surveys was 9.0, 10.2 and 9.1 per cent respectively. The average annual risk of tuberculous infection was estimated to be 1.7, 1.9 and 1.7 per cent at the three surveys respectively. Thus, the results clearly showed that, over a period of 15 yr, there was no change in the tuberculosis situation, in terms of prevalence of infection, in the study population.