A study on prevalence of symptomatic not confirmed pulmonary tuberculosis under 5 to 15 years of age in protein energy malnutrition children in a tertiary care centre
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192757Keywords:
Lymph node, Mycobacterium tuberculosis, PTB, Tuberculin skin test, PEMAbstract
Background: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children, in developing countries. Tuberculosis can be a cause of malnutrition in children and also a common cause of pneumonia in such malnourished children. In the present study ,our aim is to know the prevalence and early clinical diagnosis of symptomatic not confirmed TB, in recent challenging environment, in protein energy malnutrition children, this information would certainly help clinicians in early detection, diagnosis and management of PTB (Pulmonary Tuberculosis) in such populations ,to reduce morbidity and mortality.
Methods: We prospectively investigated protein energy malnutrition children, with clinical features of tuberculosis, between 5 to 15 years of age , admitted during 18 months of study period. Clinical and demographic data of studied children were collected. Anthropometric (Height and Weight) measurement and physical examination were made. PEM (Protein energy malnutrition) children were classified according to Indian academy of pediatric classification. History of BCG vaccination and exposure to contact were inquired. Chest radiography was done for all children in our study.
Results: A total of 150 protein energy malnutrition children, between 5 to 15 years, admitted over 18 months period were studied. Majority of children were female as compared to male and under 5 to 10 years of age. Out of these, symptomatic not confirmed pulmonary TB 93 (62%) and Extra pulmonary TB 18 (12%) and Non TB cases were 39 (26%). According to Grade of PEM, symptomatic not confirmed pulmonary TB cases under grade III were 45 (48.5%) and 35 (37.6%) were under grade II .
Conclusions: Pulmonary tuberculosis may be a common cause of pneumonia in malnourished children and the cause of death in these population. So Its frequency and early clinical detection ,even without microbiological confirmation and supportive evidence and treatment guideline should be made by more further study. So that, it will help clinicians to treat these population to reduce morbidity and mortality.
References
Moore DP, Klugman KP, Madhi SA. Role of Streptococcus pneumoniae in hospitalization for acute community-acquired pneumonia associated with culture-confirmed Mycobacterium tuberculosis in children: a pneumococcal conjugate vaccine probe study. Ped Infect Dis J. 2010;29(12):1099-04.
Adegbola RA, Falade AG, Sam BE, Aidoo M, Baldeh I, Hazlett D, et al. The etiology of pneumonia in malnourished and well-nourished Gambian children. Pediatr Infect Dis J. 1994;13(11):975-82.
Macallan DC. Malnutrition and tuberculosis. Diagn Microbiol Infect Dis. 1999; 34(2):153-7.
Schaaf HS, Marais BJ, Whitelaw A, Hesseling AC, Eley B, Hussey GD, et al. Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases. BMC Inf Dis. 2007;7(1):140.
Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis J. 2008;8(8):498-510
Marais BJ, Gie RP, Schaaf HS, Beyers N, Donald PR, Starke JR. Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med. 2006;173(10):1078-90.
Donald PR, Marais BJ, Barry CE. 3rd Age and the epidemiology and pathogenesis of tuberculosis. Lancet. 2010;375(9729):1852-4.
Rieder HL. Epidemiologic basis of tuberculosis control. 1st ed. Paris: International Union Against Tuberculosis and Lung Disease; 1999: 1-164.
Bai SS, Devi RL. Clinical spectrum of tuberculosis in BCG vaccinated children. Indian Pediatr. 2002;39(5):458-62.
Vijayakumar M, Bhaskaram P, Hemalatha P. Malnutrition and childhood tuberculosis. J Trop Pediatr. 1990;36(6):294-8.
Satyanarayana K, Bhaskaram P, Seshu VC, Reddy V. Influence of nutrition on postvaccinial tuberculin sensitivity. Am J Clin Nutr. 1980;33(11):2334-7.
Harland PS, Brown RE. Tuberculin sensitivity following B.C.G. vaccination in undernourished children. East Afr Med J. 1965;42(5):233-8.
Chadha VK, Jitendra R, Kumar P, Gupta J, Umadevi. Relationship of nutritional status with tuberculin sensitivity. Indian J Pediatr. 2009;76(6):605-7.
McMurray DN, Loomis SA, Casazza LJ, Rey H, Miranda R. Development of impaired cell-mediated immunity in mild and moderate malnutrition. Am J Clin Nutr. 1981;34(1):68-77.
Ahmed T, Sobhan F, Ahmed AMS, Banu S, Mahmood AM, Hyder KA, et al. Childhood tuberculosis: a review of epidemiology, diagnosis and management. Inf Dis J Pak. 2008;17(2):52-60.
Ling DI, Zwerling AA, Steingart KR, Pai M. Immune-based diagnostics for TB in children: what is the evidence? Ped Respir Rev. 2011;12(1):9-15.