Prediction and early diagnosis of pulmonary tuberculosis with a normal chest radiograph in the pediatric age group

ABSTRACT

Pulmonary tuberculosis in the absence of chest radiographic abnormalities has been reported recently frequently by many researchers, and its clinical features and methods of detection have not been well described in pediatrics. This is of prime importance in children, as the borders between tuberculosis infection and disease are on a continuum and often indistinct. The objective of this work is to put a strategy for early anticipation and prompt diagnosis of pulmonary TB with a normal chest radiograph in the pediatric age group. This study was conducted on 18 infants and children [5 males and 13 females], their ages ranged from 7 months to 12 years. We selected cases diagnosed as pulmonary TB with a normal chest radiograph from the chest clinic and internal sections, Cairo University Children's Hospital. The mean duration of symptoms before the time of diagnosis was 9.9 13.2 months. Proper history taking, thorough clinical examination, and investigations [CBC, ESR, Tuberculin skin test, Plain chest radiograph, and others according to each case] were done for all patients. Results revealed that pulmonary TB with a normal X-ray chest represented 24.7% of those with pulmonary extrapulmonary TB cases; TB adenitis [mostly cervical] was present in 88% of them. All patients were symptomatic at the time of diagnosis; cough and fever were the commonest symptoms [100% and 89% respectively]. Most of cases [89%] presented with? three symptoms. On the contrary, only 11% had auscultatory chest signs [wheezing]. We documented weight loss in 61% of patients, most of them [82%] with? 10[th] percentile. Twenty two percent of our patients gave a positive history of contact to an infectious adult, 75% of which were tuberculin positive. BCG scar was present in 33% of cases. In conclusion, pulmonary TB with a normal chest radiograph is not uncommon in pediatrics, it is important to establish a correct diagnosis of tuberculosis disease in children at an early stage. The patient will benefit from early diagnosis and treatment in terms of outcome and complications. Predictive factors or scoring systems should be devised based on clinical symptoms, contact tracing, and investigations. These are of crucial importance when the X-ray chest is normal or out of reach, as in rural and isolated areas; or when the sputum culture is negative, a common finding in children