[Tuberculosis in childhood: clinical features and problems in diagnosis. Report of 30 cases]. / La tuberculose de l'enfant: aspects cliniques et problèmes diagnostiques, a propos de 30 observations.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Bronchogenic cyst: an uncommon cause of congenital lobar emphysema.

We report a case of a 1-month-old boy who has developed respiratory distress. Chest X-ray and CT scan showed over distension of the left upper lobe and a mediastinal shift in favour of congenital lobar emphysema (CLE) of the left upper lobe. One month after uneventful lobectomy, he was readmitted at hospital for another episode of respiratory distress. Chest radiography revealed relapse of compressive emphysema in the remaining left lobe. Gastro oesophageal transit and MRI were performed, which have shown a mediastinal cystic mass. Accordingly, the patient underwent thoracotomy. Surgical examination found a subcarinal bronchogenic cyst which compressed the main left bronchus, causing the CLE of both upper and lower left lobes. Histological examination of removed cyst confirmed these data. Authors discuss causes of diagnostic delay.