A Clinical Review of Miliary Tuberculosis in Children

ABSTRACT

A Clinical study was made of 88 pediatric patients with miliary tuberculosis, who were admitted to the Pediatric Department of Kwangju Christian Hospital during the period of January, 1971 through December, 1980. 1) The incidence of miliary tuberculosis in children was 0.6%(88 cases) of the total pediatric admission cases(13969), and 12.5% (88 cases) of the total pediatric tuberculous patiens(705). 2) The highest incidence was found in those under the age of 3 years, comprising 63.7%(56 cases) of all cases. The sex ratio of male to female was 1.51, which is not significant. 3) The most prevalent season was Spring, with 34.1% (30 cases). 4) The source of infection was found within their family in 36.3% (32cases). 5) Only 14.8% (13 cases) had received BCG innoculation. 6) Predisposing factors were found in 24.9% (21 cases) and these were measles, chicken pox, pertussis, typhoid fever in decreasing order of frequency. 7) Chief complaints on admission in the order of frequency werefever (72.7%), coughing (68.2%), general weakeness (37.5%), vomiting (35.2%). 8) Principal clinical features on admission were marked adnormal auscltatory findings (68.2%), emaciation (54.5%), adnormal neurologic sings (42.0%), cervical lymphaderopathy (39.8%) and hepatosplenmegaly (22.7%). 9) Tuberculin skin test was done in 55 cases and positive reaction was obtained in 21.8% (12 cases). 10) Hematologic findings revealed a mild degree of anemia in 52.3% of all patients and leukocytosis in 75.0%. 11) AFB smear was positive in only 19.3% (17 cases/88), and the highest positive rate was found in sputum (40.0%). 12) Tuberculous meningitis was the most most common disease associated with miliary tuberculosis. 40.9% (36 cases( of all miliary tuberculosis cases were complicated by tuberculous meningitis, with the highest incidence of 72.2% (56 cases) under the age of 3 years. 13) The usual treatment was the triple regimen of INH, PAS and SM, though PAS was replaced by EMB or Rifampin in recent cases, Corticosteroids were added in complicated cases. 14) In 21.6% (19 cases) of total cases, the clinical symptoms and the miliary density on X-ray disappeared after 3 months of treatment. 15) The mortality rate was 10.2% (9 cases/88).