engleski

Epidemiological trends in children with tuberculosis (1996-2000)

We compared epidemiological characteristics of 30 children treated for tuberculosis (Tbc) in Pediatric Clinic 1990-95 (P1), during the war in Croatia (Dragišić-Ivulić, S. et al. Eur Respir J 1998 ; 12, Suppl 28: 136) with 18 children treated in period 1996-2000 (P2). Total of 48 children were treated and incidence was 3.2+/-1.6 (except for year 1994 when we had quadruple increase (17), mostly refugees from Bosnia and Herzegovina (BH). Number of cases from BH reduced (P1: 35%, P2: 22%). Ratio pulmonary/extrapulmonary Tbc: P1: 24/6, P2: 13/5. Extrapulmonary: P1: pleuritis 2, genitourinary 1, lymphadenitis 2, connate 1 ; P2: pleuritis 1, genitourinary 2, bone 1, meningitis 1. According to the age: P1: 0-4 y: 43%, 5-9 y: 13%, 10-14 y 43%, P2: 0-4 y: 50%, 5-9 and 10-14 y: 11%, >14 y: 28%. Males were presented by 67% in P1 and 39% in P2. Similar % of patients were found by preventive cure (contact with Tbc patient, positive PPD test) in both periods (40% P1, 39% P2). PPD test was negative in 13% of P1, and 22% of P2 patients, 6–14 mm in 13%(P1), 22%(P2), equal and more than 15 mm in 30%(P1), 50%(P2) and even vesicular in 43%(P1), 22%(P2). 77% P1 and 61% P2 were successfully BCG immunizated. The bacteriological culture was positive in 50% P1 and 39% P2 children. Mycobacterium tuberculosis (MyTbc) was isolated mainly from gastric lavage (28% P2) and once from liquor, bronchoscopy specimen, expectorated sputum, urine and bone biopsy. We had 2 cases of smear-positive acid-fast bacilli (bronchoscopy specimen, gastric lavage), both in P2. Isolated MyTbc was resistant to isoniasid in 3(P1) and 1(P2) patient. Radiographic manifestations were found in 27(P1) and 14(P2) patients, specific parenchymal lesions with lymphadenopathy 10(P-1), 5(P-2), only parenchymal lesions 7(P1) and 6(P2), only lymphadenopathy 8(P1) and 3(P2), pleuritis 2(P1) and 1(P2) patient. Conclusion: The youngest children (0-4 y) are the most vulnerable (50%), followed by older than 14 y (28%). PPD test (positive 78%), radiographic finding (positive 78%) and bacteriological culture (positive 39%) are the most important elements for diagnosis and therapy of Tbc in children. The resistance to isoniasid in our sample was 5, 5%.

Epidemiology; Tuberculosis; Children

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