RESUMEN
Until recently paediatric tuberculosis rates were in decline in developed countries, but more recently there has been a significant change in these trends. Tuberculosis in British Columbia (BC) is centralized and all paediatric cases diagnosed between 1979 and 1988 were reviewed. There were 252 notifications during the study period but 50 cases were excluded (31 extrapulmonary cases, 11 with missing records and 8 because of incorrect diagnoses). There were 109 (54%) female patients. The age range was 4 months-15 years (6.4 +/- 4.1 years). 52% were 5 years old or less. 75 (37.1%) were aboriginal Canadians, 61 (30.2%) were Asian, 50 (24.8%) were Caucasian and 16 (8%) were included in miscellaneous or unknown groups. Primary pulmonary disease occurred in 197 (97.5%); the remaining 5 had post-primary disease. A history of close contact was elicited in 158 children (78.2%). All but 8 (4%) had a positive PPD response to 5TU. 40% of children had symptoms, the most frequent being cough (51%) and fever (28.4%). Mycobacteriology was carried out in 169 (83.7%) children. Bacteriologic confirmation was achieved in 45 patients (22.2%). Chest X-rays were reviewed in 186 cases. Lymphadenopathy occurred in 93.5%, with hilar (34%) and combined hilar-paratracheal (26%) being the commonest findings. The majority of patients were treated with isoniazid and rifampin, with a minority receiving streptomycin or pyrazinamide in the initial intensive phase. 14 (6.9%) children had adverse reactions to their drugs but these were rapidly reversed with the withdrawal of the responsible drug. Response to therapy was excellent and there were no deaths.
Asunto(s)
Tuberculosis Pulmonar/epidemiología , Adolescente , Antituberculosos/efectos adversos , Colombia Británica/epidemiología , Niño , Preescolar , Farmacorresistencia Microbiana , Quimioterapia Combinada , Femenino , Humanos , Incidencia , Lactante , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Mycobacterium tuberculosis/efectos de los fármacos , Cooperación del Paciente , Radiografía , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
The aim of the study was to review the radiologic features of primary tuberculosis in childhood and to determine whether differences in patterns of disease occur among age and ethnic groups. Chest radiographs of 191 children with pediatric primary tuberculosis were reviewed by two observers. Lymphadenopathy, present in 92% of cases, was the most common abnormality identified on the initial chest radiograph and typically involved the hilar and paratracheal regions. Parenchymal abnormalities, identified in 70% of cases, occurred more commonly in the right lung (P less than .001). Children 0-3 years of age had a higher prevalence of lymphadenopathy (P less than .01) and a lower prevalence of parenchymal abnormalities (P less than .001) than older children. A lower prevalence of lymphadenopathy was found in whites than in nonwhites (P less than .02). The radiologic abnormalities often progressed in the initial follow-up. Lymphadenopathy, with or without concomitant parenchymal abnormality, is the radiologic hallmark of primary tuberculosis in childhood. However, distinct age-related and racial differences in presenting patterns of disease exist and should be recognized.
Asunto(s)
Tuberculosis Ganglionar/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Factores de Edad , Colombia Británica/epidemiología , Niño , Femenino , Humanos , Masculino , Prevalencia , Grupos Raciales , Radiografía Torácica , Tuberculosis Ganglionar/etnología , Tuberculosis Pulmonar/etnologíaRESUMEN
The activity of adenosine deaminase in the pleural fluid of 218 consecutive patients was studied. According to the etiology of exudative pleural effusions, the patients were divided into the following five groups: (1) tuberculosis; (2) lung cancer; (3) pneumonias; (4) miscellaneous; and (5) idiopathic. Patients with pleural tuberculosis presented significantly higher ADA activity than patients with nontuberculous pleural effusions (p less than 0.0001). The results indicated that in a population with a relatively high prevalence of tuberculosis, the analysis of ADA levels in pleural effusions constitutes a useful marker for the diagnosis which, in addition, can be made quickly and cheaply. Additionally, a comprehensive review of the literature on the role of ADA in the diagnosis of tuberculous pleural effusions is presented.