DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180055

Profile and outcome of childhood tuberculosis treated with DOTS at a tertiary care hospital in central India: an observational study

Anjali Bharani, Mohini Harshey, Swati Raipurkar

Abstract


Background: Children contribute a significant proportion of the tuberculosis (TB) burden in India and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary (EPTB) is challenging. The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis.

Methods: A retrospective analysis of 90 cases of TB in children within 2 year period was conducted at Pediatric Department and DOTS center at a tertiary care hospital from January 2015 to December 2016.

Results: In the present study 20% of the total TB patients attending DOTS OPD were Children. Most common symptoms were Fever (53.3 %), Cough (46.6%), abdominal pain (18.8%), lymphadenopathy (13.3%), osteo-articular symptoms (13.3%), weight loss (10%), CNS related complaints like convulsions and unconsciousness (6.6%). History of contact was present in 10 cases (11%). Sputum examination was positive in 9 cases (10%) who were predominantly older children above 12 years. Mantoux test was positive in 9 cases (10%). Only one patient was HIV positive.  Extra pulmonary tuberculosis (EPTB) patients were more common than pulmonary. 47 out of the 90 cases (52%) were receiving DOTS for EPTB. Out of the 90 cases 84 (93.3%) were on New Category 1 treatment and 6 (6.6%) were on Cat 2 treatment. Out of the total 90 cases 3 defaulted, 3 died, rest completed treatment with good compliance and no side-effects and were declared cured.

Conclusions: In present study, it was found that extra-pulmonary tuberculosis (EPTB) patients are more common than pulmonary tuberculosis in pediatric age group. Sputum positivity yield is very low in pediatric age group. Success of treatment with DOTS is good (94.4%). No adverse effects of ATT were observed.


Keywords


Children, DOTS, Outcome, Tuberculosis

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References


Guidance for national tuberculosis programmes on the management of tuberculosis in children WHO/HTM/TB/2006.371.[Cited 2010 Aug 3]. Available at http://www.who.int/child_adolscent_health/documents/htm_tb_2006_371/en/index.html.

Frieden TR. Directly observed treatment, short-course (DOTS): Ensuring cure of tuberculosis. Indian J Pediatr. 2000;67:S21-7.

Chauhan LS, Arora VK, Central TB. Division, Directorate General of Health services, Ministry of Health and family Welfare; Indian Academy of Pediatrics. Management of pediatric TB under the Revised National Tuberculosis Control Programme (RNTCP). Indian Pediatr. 2004;41:901-5.

Kabra SK, Lodha R, Seth V. Category based treatment of tuberculosis in children. Indian Pediatr. 2004;41:927-37.

Gupta R, Garg A, Venkateshwar V, Kanitkar M. Spectrum of childhood tuberculosis in BCG vaccinated and unvaccinated children. MJAFI. 2009;65:305-7.

Balasubramanian VN, Oomen K, Samuel R. DOT or not? Direct observation of antituberculosis treatment and patient outcomes, Kerala state, India. Int J Tuberc Lung Dis. 2000;4:409-13.

Indumathi CK, Prasanna KK, Dinakar C, Shet A, Lewin S. Intermittent short course therapy for pediatric tuberculosis. Indian Pediatr. 2010;47:93-6.

Sivanandan S, Walia M, Lodha R, kabra SK. Factors associated with treatment failure in childhood tuberculosis. Indian Pediatr. 2008;45:769-71.

Bai SS, Devi RL. Clinical spectrum of tuberculosis in BCG vaccinated children. Indian Pediatr. 2002;39:458-62.

Shrestha S, Marahatta SB, Poudyal P, Shrestha SM. Clinical profile and outcome of childhood tuberculosis at Dhulikhel Hospital. J Nepal Pediatr Soc. 2011;31:11-6.

Sreeramareddy CT, Ramakrishnareddy N, Shah RK, Baniya R, Swain PK. Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis. BMC Pediatr. 2010;10:57.

Vijayasekaran D, Kumar AR, Gowrishankar NC, Nedunchelian K, Sethuraman S. Mantoux and contact positivity in tuberculosis. Indian J Pediatr. 2006;73:989-93.

Agarwal M, Koppikar GV, Ghildiyal R, Charvakar M, Joshi SM, Lahiri KR. Seropositivity rate for HIV infection in hospitalized children on selective screening. Indian Pediatr. 2001;38:267-71.

Lahiri S, Shahab T, Malik A, Alam S. HIV seropositivity in hospitalized children with high likehood of AIDS. Indian Pediatr. 2000;39:372-5.

Sharma S, Sarin R, Khalid UK, Singla N, Sharma PP, Behera D. The DOTS strategy for treatment of pediatric pulmonary tuberculosis in South Delhi. India Int J Tuberc Lung Dis. 2008;12:74-80.

Venugopal K, Sreelatha PR, Philip S, Kumar V. Treatment outcome of neuro tuberculosis patients put on DOTS- An observational study from the field. Indian J Tuber. 2008;55:199-202.