Childhood tuberculosis in southern Taiwan, with emphasis on central nervous system complications

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Abstract

Background/Purpose: Childhood tuberculosis (TB) continues to be a major public health problem in Taiwan. Taiwan remains a highly endemic area despite neonatal Bacillus Calmette-Guérin (BCG) vaccination and the availability of anti-TB therapy. The presentation is highly variable and it is often difficult to make an accurate diagnosis. This study was designed to evaluate the demographic, clinical, and laboratory findings and outcomes of TB in children with emphasis on central nervous system (CNS) complications. Methods: The medical records of 80 children diagnosed with TB at a medical center in southern Taiwan over the past 24 years (1988-2012) were reviewed. Results: Among them, 48.8% (39/80) had pulmonary TB, 27.5% (22/80) had isolated extrapulmonary TB, and 23.7% (19/80) had disseminated TB. Most infected cases were aged either<4 years or > 12 years. TB contact history was found in 42.5% (34/80) cases. Fourteen (17.5%) of the cases had CNS involvement. The most common presentations were fever (85.7%), signs of increased intracranial pressure (71.4%), drowsiness (64.3%), and focal neurological signs (57.1%). The major radiological findings were tuberculoma (50%), basilar enhancement (41.6%), infarction (41.6%), hydrocephalus (16.6%), and transverse myelitis (16.6%). The case fatality of CNS TB was 14.3% and 21.4% had neurologic sequelae. Conclusion: Findings suggest that positive exposure history and suspicious clinical presentations are important clues for further confirmatory laboratory and image studies in childhood TB. CNS TB usually presented as part of disseminated TB in children. Early diagnosis and treatment may lead to favorable outcomes in CNS TB.

Original languageEnglish
Pages (from-to)503-511
Number of pages9
JournalJournal of Microbiology, Immunology and Infection
Volume47
Issue number6
DOIs
Publication statusPublished - 2014 Dec 1

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Taiwan
Tuberculosis
Central Nervous System
Central Nervous System Tuberculosis
History
Transverse Myelitis
Tuberculoma
Sleep Stages
Intracranial Pressure
Hydrocephalus
Pulmonary Tuberculosis
Infarction
Bacillus
Nervous System
Medical Records
Early Diagnosis
Vaccination
Fever
Public Health
Demography

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{cc734d688f04483cb08730476b735891,
title = "Childhood tuberculosis in southern Taiwan, with emphasis on central nervous system complications",
abstract = "Background/Purpose: Childhood tuberculosis (TB) continues to be a major public health problem in Taiwan. Taiwan remains a highly endemic area despite neonatal Bacillus Calmette-Gu{\'e}rin (BCG) vaccination and the availability of anti-TB therapy. The presentation is highly variable and it is often difficult to make an accurate diagnosis. This study was designed to evaluate the demographic, clinical, and laboratory findings and outcomes of TB in children with emphasis on central nervous system (CNS) complications. Methods: The medical records of 80 children diagnosed with TB at a medical center in southern Taiwan over the past 24 years (1988-2012) were reviewed. Results: Among them, 48.8{\%} (39/80) had pulmonary TB, 27.5{\%} (22/80) had isolated extrapulmonary TB, and 23.7{\%} (19/80) had disseminated TB. Most infected cases were aged either<4 years or > 12 years. TB contact history was found in 42.5{\%} (34/80) cases. Fourteen (17.5{\%}) of the cases had CNS involvement. The most common presentations were fever (85.7{\%}), signs of increased intracranial pressure (71.4{\%}), drowsiness (64.3{\%}), and focal neurological signs (57.1{\%}). The major radiological findings were tuberculoma (50{\%}), basilar enhancement (41.6{\%}), infarction (41.6{\%}), hydrocephalus (16.6{\%}), and transverse myelitis (16.6{\%}). The case fatality of CNS TB was 14.3{\%} and 21.4{\%} had neurologic sequelae. Conclusion: Findings suggest that positive exposure history and suspicious clinical presentations are important clues for further confirmatory laboratory and image studies in childhood TB. CNS TB usually presented as part of disseminated TB in children. Early diagnosis and treatment may lead to favorable outcomes in CNS TB.",
author = "Cho, {Yu Hao} and Ho, {Tzong Shiann} and Wang, {Shih Min} and Shen, {Ching Fen} and Chuang, {Po Kai} and Liu, {Ching Chuan}",
year = "2014",
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doi = "10.1016/j.jmii.2013.06.008",
language = "English",
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T1 - Childhood tuberculosis in southern Taiwan, with emphasis on central nervous system complications

AU - Cho, Yu Hao

AU - Ho, Tzong Shiann

AU - Wang, Shih Min

AU - Shen, Ching Fen

AU - Chuang, Po Kai

AU - Liu, Ching Chuan

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background/Purpose: Childhood tuberculosis (TB) continues to be a major public health problem in Taiwan. Taiwan remains a highly endemic area despite neonatal Bacillus Calmette-Guérin (BCG) vaccination and the availability of anti-TB therapy. The presentation is highly variable and it is often difficult to make an accurate diagnosis. This study was designed to evaluate the demographic, clinical, and laboratory findings and outcomes of TB in children with emphasis on central nervous system (CNS) complications. Methods: The medical records of 80 children diagnosed with TB at a medical center in southern Taiwan over the past 24 years (1988-2012) were reviewed. Results: Among them, 48.8% (39/80) had pulmonary TB, 27.5% (22/80) had isolated extrapulmonary TB, and 23.7% (19/80) had disseminated TB. Most infected cases were aged either<4 years or > 12 years. TB contact history was found in 42.5% (34/80) cases. Fourteen (17.5%) of the cases had CNS involvement. The most common presentations were fever (85.7%), signs of increased intracranial pressure (71.4%), drowsiness (64.3%), and focal neurological signs (57.1%). The major radiological findings were tuberculoma (50%), basilar enhancement (41.6%), infarction (41.6%), hydrocephalus (16.6%), and transverse myelitis (16.6%). The case fatality of CNS TB was 14.3% and 21.4% had neurologic sequelae. Conclusion: Findings suggest that positive exposure history and suspicious clinical presentations are important clues for further confirmatory laboratory and image studies in childhood TB. CNS TB usually presented as part of disseminated TB in children. Early diagnosis and treatment may lead to favorable outcomes in CNS TB.

AB - Background/Purpose: Childhood tuberculosis (TB) continues to be a major public health problem in Taiwan. Taiwan remains a highly endemic area despite neonatal Bacillus Calmette-Guérin (BCG) vaccination and the availability of anti-TB therapy. The presentation is highly variable and it is often difficult to make an accurate diagnosis. This study was designed to evaluate the demographic, clinical, and laboratory findings and outcomes of TB in children with emphasis on central nervous system (CNS) complications. Methods: The medical records of 80 children diagnosed with TB at a medical center in southern Taiwan over the past 24 years (1988-2012) were reviewed. Results: Among them, 48.8% (39/80) had pulmonary TB, 27.5% (22/80) had isolated extrapulmonary TB, and 23.7% (19/80) had disseminated TB. Most infected cases were aged either<4 years or > 12 years. TB contact history was found in 42.5% (34/80) cases. Fourteen (17.5%) of the cases had CNS involvement. The most common presentations were fever (85.7%), signs of increased intracranial pressure (71.4%), drowsiness (64.3%), and focal neurological signs (57.1%). The major radiological findings were tuberculoma (50%), basilar enhancement (41.6%), infarction (41.6%), hydrocephalus (16.6%), and transverse myelitis (16.6%). The case fatality of CNS TB was 14.3% and 21.4% had neurologic sequelae. Conclusion: Findings suggest that positive exposure history and suspicious clinical presentations are important clues for further confirmatory laboratory and image studies in childhood TB. CNS TB usually presented as part of disseminated TB in children. Early diagnosis and treatment may lead to favorable outcomes in CNS TB.

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