NGHIÊN CỨU ĐẶC ĐIỂM BỆNH LAO TRẺ EM TẠI BỆNH VIỆN PHỤ SẢN NHI ĐÀ NẴNG

Abstract

Background: Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. In children, about 1 million estimated new cases of TB yearly in children younger than 15 years, almost two-thirds are either undiagnosed or untreated. TB can damage many organs in the body with diverse signs and symptoms; meanwhile, Pulmonary TB is the most prevalent type. If early detection and reaching approach treatment with specifc medicine, this disease can be completely cured.

Objectives: To determine the demographic, risk factors, clinical, and subclinical presentations, and the initial assessment of tuberculosis treatment in children.

Subjects and Methods: The medical records of novel patients hospitalized with the diagnosis of pulmonary tuberculosis and extrapulmonary tuberculosis in Da Nang Hospital for Women and Children between September 2020 and September 2022 were evaluated retrospectively.

Results: TB in children happens mainly over 5 years old (72.2%). The male/female ratio was 1.5/1. 36.1% of children with TB have an identifed source of infection, mainly from their fathers. In the group of children with tuberculosis, 36.1% were underweight and malnourished, 2.8% were infected with HIV, and 16.7% had accompanying chronic diseases 61.1% had pulmonary tuberculosis, 38.9% had extrapulmonary tuberculosis, 40.9% had simple pulmonary tuberculosis, 59.1% had pulmonary tuberculosis with tuberculosis of other organs. In the group of extrapulmonary tuberculosis, lymph node tuberculosis accounted for 35.7%, pleural tuberculosis brain accounted for 35.7%, pleural tuberculosis accounted for 14.3%, spinal tuberculosis accounted for 7.1%, and muscle tuberculosis accounted for 7.1%. Systemic symptoms of children with TB: fever (69.4%), fatigue/poor playfulness (22.2%), and weight loss (19.4%). Respiratory symptoms: cough lasting > 2 weeks in 85.7%, pleural effusion in 47.6%, respiratory failure in 28.6%, chest pain in 19%, hemoptysis in 9.5%. Neurological symptoms: weakness/paralysis of limbs (80%), disturbance of consciousness (60%), headache (40%), convulsions (40%), cranial nerve paralysis (20%), and stiff neck/bulging fontanel (20%). Paraclinical characteristics: 61.1% of cases had bacteriological evidence (GenXpert/AFB sputum/TB PCR), mainly GenXpert positive, erythrocyte sedimentation increased in 87.5%, images of lesions suspected of tuberculosis on chest X-ray was 66.7% (24/36), images of suspected tuberculosis lesions on CT Scan/MRI accounted for a fairly high rate of 96.3% (26/27). The mortality rate was 2.8% (1/36) in cases of miliary tuberculosis/congenital immunodefciency. 63.9% used antibiotics before being diagnosed with TB. 11.1% experienced side effects of tuberculosis drugs. 47.2% had complications during the hospital stay. 19.4% of children had surgical intervention

Conclusion: Childhood Tuberculosis is common in children over 5 years old and the male proportion is larger. Which, Pulmonary Tuberculosis is the most prevalent. In the group of Extrapulmanory Tuberculosis, TB lymphadenitis, and meningitis take the larger proportions. The universal signs and symptoms in our patients are fever, a persistent cough (> 2 weeks), and pleural effusion. About 2/3 of total TB patients were diagnosed by the evidence of bacteriology (in which, the majority is the positive Gene Xpert TB test). The mortality rate due to tuberculosis in the study was 2.8%, which was in immunocompromised patients.