Spectrum Of Adolescent Tuberculosis in a Tertiary Care Hospital at Shimla, North India.
Keywords:
Pulmonary tuberculosis, extra-pulmonary tuberculosis, adolescent
Abstract
Background: Tuberculosis amongst adolescents is distinct from both childhood and adult tuberculosis in terms of incidence, disease manifestations and response. These peculiarities are due to issues related to immunity, hormone imbalance, social interactions and psychology unique to this phase of life. Adolescent tuberculosis remains a less studied area in India. Aims: To study the spectrum of tuberculosis in adolescents.Methods: We analyzed demographic, clinical and paraclinical data from 477 adolescents (10-19 years of age) diagnosed to have Tuberculosis, who reported to the in the Department of paediatrics, Indira Gandhi Medical College, Shimla between the years 2010 and 2014. Results: The incidence of tuberculosis among hospital visiting adolescents was 0.8%.The incidence in females (1.00 %) was significantly more in comparison to males (0.63 %) with females having (OR1.60) 1.60 times more odds of suffering from Tuberculosis than males (p< 0.001). Isolated Pulmonary tuberculosis (PTB) was seen in 52% cases, extrapulmonary tuberculosis (EPTB) in 40 % and combined PTB with EPTB in 8 % cases. The most common forms of extrapulmonary tuberculosis were pleural effusion (25.6%) and central nervous system tuberculosis (24.7%). Infiltration (consolidation) was the most common chest x-ray finding (53.7 %). Conclusion: Pulmonary disease accounted for high proportion of tubercular cases. Among Extrapulmonary forms isolated pleural effusion and central nervous system tuberculosis were the most common closely followed by abdominal tuberculosis, while lymphadenitis was less common. The incidence among females was significantly high in comparison to males (P<.001).References
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2. Dye C, Scheele S, Dolin P et al: Global burden of disease: estimated incidence, prevalence, and mortality by country. J Am Med Assoc 1999; 282: 677-86.
3. Global tuberculosis report 2012-http://www.who.int/tb/publications/global_report/gtbr12_executivesummary.pdf. April 2, 2013.
4. Jayasree Poroor, Doye George. ”Tuberculosis in Adolescents and Children: Data on Clinical Presentation and Treatment Outcomes for a Period of 4 Years, from a tertiary care hospital in South India”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 18, May 04, 2015; Page: 2752-2757.
5. Swaminathan S, Banu R. Pediatric Tuberculosis: Global overview and challenges.Clin Infect Dis 2010; 50: 184–194.
6. Smith MHD. Tuberculosis in adolescents. ClinPediatr1967; 6:9-15.
7. Wilcox WD, Laufer S. Tuberculosis in Adolescents. A Case Commentary. ClinPediatr1994; 33:258-262.
8. Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis 2004; 8:636–647.
9. Raina N, Nayar PD, Mehta R, Dawa N. Adolescent Health and Development. In Ghai OP, Paul VK, Bagga A edGhai Essential Pediatrics; 7th edition; New Delhi: CBS Publishers, 2009: p42.
10. Central TB Division. RNTCP at a glance. http://www.tbcindia.nic.in/pdfs/RNTCP%20at%20a%20Glance.pdf. April 2, 2013
11. Waako et al. Burden of tuberculosis disease among adolescents in a rural cohort in Eastern Uganda : BMC Infectious Diseases 2013, 13:349 http://www.biomedcentral.com/1471-2334/13/349
12. Uppada et al .Incidence of tuberculosis among school going adolescents in South India : BMC Public Health (2016) 16:641
13. Mahomed H, Ehrlich R, Hawkridge T, Hatherill M, Geiter L, et al. (2013) TB Incidence in an Adolescent Cohort in South Africa. PLoS ONE 8(3): e59652.
14. Franco R, Santana M, Matos E, Sausa V, Lemos AC. Clinical and Radiological Analysis of Children and Adolescents With Tuberculosis in Bahia, Brazil . Braz J Infect Dis2003;7(1): 73-81.
15. Phongsamart, Wanatpreeya MD, Kitai et al. A Population-Based Study of Tuberculosis in Children and Adolescents in Ontario.Pediatr Infect Dis J: 2009; 28 (5): 416-419.
16. De Pontual L, Balu L, Ovetchkine P et al. Tuberculosis in adolescents; A French retrospective study of 52 cases. Pediatr Infect Dis J.2006 ;25(10):930-2.
17. Cruz AT, Hwang KM, Birnbaum GD, Starke JR. Adolescents with tuberculosis: a review of 145 cases. Pediatr Infect Dis J. 2013 Sep;32(9):937-41. http://dx.doi.org/10.1097/INF.0b013e3182933214 PMid:23538527
18. Shrivastava AK, Brahmachari S, Pathak P, Kumar Ratan, SainiaT, Patel U, Mandil A. Clinico-Epidemiological Profile of Extra-pulmonary Tuberculosis in Central India. Int J Med Res Rev 2015;3(2):223-230.
19. Lotfian F., Bolursaz M. R., Khalilzadeh S., Baghaie N., Hassanzad M., Velayati A. Features of Adolescents Tuberculosis at a Referral TB's Hospital in Tehran, Iran. Mediterr J Hematol Infect Dis 2016, 8(1): e2016005,
20. Didelescu C, Ibraim E, Tigau M. The epidemiology profile and current evolutionary trends in Tuberculosis in adolescents (15-19 years old). Pneumoftiziologia1997; 46(3): 193-9
21. Maltezou HC, Spyridis P. Extrapulmonary Tuberculosis in children. Arch Dis Child, 2000;83(4):342-6.
22. R. Bryan Rock, Michael Olin, Cristina A. Baker, Thomas W. Molitor, and Phillip K. Peterson . Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects. Clin Microbiol Rev. 2008 Apr; 21(2): 243–261
23. Sant'Anna CC, Schmidt CM, March Mde F, Pereira SM, Barreto ML. Radiologic findings of pulmonary tuberculosis in adolescents. Braz J Infect Dis. 2011 Jan-Feb;15(1):40-4.
24. Sant'Anna C, March MF, Barreto M, Pereira S, Schmidt C. Pulmonary tuberculosis in adolescents: radiographic features.Int J Tuberc Lung Dis. 2009;13(12):1566-8.
25. Weber HC, Beyers N, Gie RP, Schaaf HS, Fish T, Donald PR. The clinical and radiological features of tuberculosis in adolescents. Ann Trop Paediatr. 2000 Mar;20(1):5-10.
26. Nelson LJ, Schneider E, Wells CD, Moore M. Epidemiology of childhood tuberculosis in the United States, 1993-2001: the need for continued vigilance. Pediatrics. 2004 Aug;114(2):333-41. http://dx.doi.org/10.1542/peds.114.2.333 PMid:15286213
27. Nooshin Baghaie, Soheila Khalilzade, Mohammad Reza Boloursaz, Amir Ali Khodayari, and Ali Akbar Velayati. Extra Pulmonary Tuberculosis in Children: Two Years Study. Acta Medica Iranica 2010; 48(4): 239-243.
Published
2017-01-02
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