Clinical profile of Children with Mediastinal Tuberculosis

Abstract

Background: Tuberculosis (TB) is a significant public health issue. India is responsible for one-fifth of all global cases, according to the World Health Organization's (WHO) yearly report .The most common form of tuberculosis in children is lung-only PTB. Extrapulmonary TB (NPTB) is the term for the condition in which the TB bacteria spreads the infection outside of the lungs.(EPTB)

Aim & ojectives: To study clinical profile of children with mediastinal tuberculosis (TB).

Methods and Materials: This retrospective study was undertaken between January 2015 and March 2018 in children diagnosed with mediastinal TB. Clinical history, examination and radio imaging, such as chest X-ray and HRCT chest, were done in every patient at the start of therapy. The prevalence of mediastinal TB was calculated. Factors associated with mediastinal TB and associated pulmonary TB (PTB) were analysed.

Results: Out of total 406 patients with TB, 58 (4.12%) had mediastinal involvement. Fever was seen in 49 (84.5%) patients, positive Mantoux test (MT) in 16(80%), cough in 40.13%, loss of appetite in 43.75% and weight loss in 28.4%). Associated PTB was present in 35.2% patients. Associated extrapulmonary TB (EPTB) was observed in 22.7% patients. 11.25% patients had an abnormal X-ray. Baseline HRCT chest was done in 89.32% patients and all of them showed necrotic caseous mediastinal nodes. Treatment duration of patients who completed treatment with first-line anti-tuberculous therapy was 11.42 months. 17 patients (29.3%) were diagnosed to have drug-resistant TB (DR-TB). Cough was seen more commonly in patients with associated PTB (80%) as compared to isolated mediastinal TB (42.68%) (p =0.034).

Conclusion: Mediastinal TB is common in children with EPTB. Associated PTB is seen in only about one-third of the patients. X-ray chest is abnormal in half the patients; hence, HRCT chest may be required to make a diagnosis. Bacteriological confirmation is necessary due to high incidence of DR-TB in these patients. Most of the patients require treatment for a longer duration as resolution takes a longer time. Computed tomography imaging on follow-up helps to determine the treatment duration.