[Tuberculosis in childhood: clinical features and problems in diagnosis. report of 30 cases]

The clinical polymorphism and the low yield bacteriological tests make the diagnosis of tuberculosis [TBC] in children often difficult. The aim of this report is to specify hospital incidence of childhood TBC and to discuss problems in diagnosis. We reviewed retrospectively cases of TBC enrolled at Medicine A Department in Children's Hospital of Tunis during the last ten years [1998 - 2007]. Diagnosis of TB was supported according to bacteriological or histological confirmation or regarding the association of epidemiological data [TB contagium], clinical and radiological findings and favourable outcome with anti tuberculous drugs. Thirty children had TBC. They were 18 girls and 12 boys. The main age at diagnosis was 8. 6 years [3 months-14 years]. All children were vaccinated with BCG. Thirteen patients had definite familial history of TBC contact. Tuberculin-skin test was positive in 15 patients. The diagnosis was supported within a mean period of 44 days [8, 240 days]. Pulmonary TBC occurred in five patients and extra-pulmonary TBC in 25. Four patients had more than two TBC localizations. Miliary and TBC meningitis occurred in seven patients. The rate of diagnosis confirmation was 40%. Clinical outcome improved in 29 children with anti tuberculosis therapy while one infant died with miliary TBC. Five patients developed pleural, neurological or bone sequelaes and another patient presented autoimmune bicytopenia, diffuse bronchectasis and pulmonary aspergillosis. TBC occurs in 0, 91/ year/1000 hospitalized children in our institution. Low diagnosis confirmation rate was observed with infants and in pleural and primary TBC. Although all patients received BCG vaccine, 23. 3% of them developed a life-threatening form of TBC

[Sensibilization to pollen in asthmatic child. A study of 86 cases]

This retrospective study was designed to determine the place of pollen sensibilization in asthmatic child and to assess its epidemiological and clinical characteristics. 86 from 638 asthmatic child were allergic to pollen and included in the study. The mean age was 4 years [extremes: 1-12 years]. The mean age of first respiratory manifestations was 1 and half years. The male/ female ratio was 1.46. Asthmatic attacks was noted in 77% of cases, chronic cough was the only allergic manifestation in 16% of cases. Associated rhinitis or conjunctivitis were found in 55% of cases , atopic dermatitis was found in 4 patients [4,6% of cases]. Atopic asthma was per annual in 78% of cases. Pollinic asthma was diagnosed in 51 child. Other sensibilization were found in 60% of cases. 26 child [32%] were allergic to pollen only and 18 child to sample pollen. The gramineae pollen sensibilization is the most commun allergy. followed by olive tree and cypress tree and herbaceous pollens

[Prevalence and severity of asthma, allergic rhinoconjunctivitis and atopic eczema in "Grand Tunis" schoolchildren. ISAAC]

The aim of this study was to assess the prevalence and severity of asthma, allergic rhinoconjunctivitis and atopic eczema in 13 - 14 year old children living in "Grand Tunis", Using the international study of asthma and allergies in childhood [ISAAC] questionnaire, 3350 schoolchildren aged 13-14 years, from the Grand Tunis [Ariana, Ben Arous, Manouba, Tunis] were studied. Our results showed that in the past year 13.2% of children had wheezed, 1.4% had more than 12 attacks and 4.3% had experienced a speech limiting attack. 29.7% had symptoms of allergic rhinoconjunctivitis and 8.3% atopic eczema. The classic preponderance of asthma in boys has not been retrieved in our study. The highest level of wheeze was found in an agricultural area. According the published data, asthma prevalence in Tunisian schoolchildren is intermediate and allergic diseases are perhaps a common childhood diseases in Tunisia