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Pediatrik Tüberküloz Olgularının Klinik ve Laboratuvar Özelliklerinin Nutrisyon Göstergeleri Eşliğinde Incelenmesi

Year 2019, Volume: 19 Issue: 1, 96 - 107, 22.03.2019
https://doi.org/10.17098/amj.542155

Abstract

Amaç: Çocukluk çağı tüberkülozu önemli bir halk sağlığı
sorunudur. Pediatrik tüberküloza sıklıkla zayıflık ile karakterize malnutrisyon
eşlik eder. Bu çalışmada pediatrik tüberküloz hastalarının nutrisyon
göstergeleri eşliğinde değerlendirilmesi amaçlandı. 



Materyal ve Metot: Tüberküloz tanısı almış hastaların demografik,
klinik, antropometrik, mikrobiyolojik, histopatolojik ve radyolojik özellikleri
geriye dönük olarak incelendi. 



Bulgular: Çalışmaya 77 olgunun verileri dahil edildi. Olguların
ortalama yaşı 9,32±4,91 yıl, %63’ü erkekti. Kesin tüberküloz tanısı alan 24
(%31), olası tüberküloz tanısı alan 39 (%50) ve latent tüberküloz tanısı alan
14 (%18) hasta vardı. Kesin tanılı grupta olguların %33’ünde aside dirençli
bakteri görüldü, %20’sinde kültür pozitifti, %45’inde hem aside dirençli
bakteri görüldü hem kültür pozitifti. Olguların %40’ı akciğer, %32’si akciğer
dışı, %6’sı miliyer, %2’si akciğer ve akciğer dışı tüberküloz birlikteliğiydi.
Akciğer tübekülozu tanılı hastaların yaş ortalaması akciğer dışı + miliyer
tüberküloz tanılı hastaların yaş ortalamasından anlamlı olarak daha büyüktü
(p=0,003). Kültür pozitifliği oranı akciğer tüberkülozu grubunda, tanısal
histopatolojik örnekleme oranı akciğer dışı + miliyer tüberküloz grubunda daha
yüksekti (p=0,019, p=0,012). Temas öyküsü oranı %37, ev içi temas oranı %23
olarak saptandı, en sık indeks vakalar babalardı. Tüberkülin deri testi kesin
tüberküloz tanılı 11 hastada (%45), olası tüberküloz tanılı 15 hastada (%38)
pozitifti. Kesin ve olası tüberküloz grupları arasında cinsiyet, ortalama yaş,
yakınma süresi, tüberkülin testi pozitifliği, Bacille Calmette-Guerin skarı
varlığı, temas öyküsü oranı, hematolojik testler ve antropometrik ölçümler
açısından anlamlı farklılık yoktu (p>0,05). Olguların tanı anında yaşa göre
boy median yüzde değerlerinin ortalaması (94,35±7,50) ve boya göre ağırlık
median yüzde değerlerinin ortalaması (85,72±6,92) hafif malnutrisyonu
göstermekteydi ve bu durum tedavi bitiminde de devam etmekteydi. Yaşa göre boy
dikkate alındığında kronik malnutre olan grup olası tüberküloz grubuydu, bu
grupta yakınma süresi ortancası 3 aydı. Boya göre ağırlık (<5 yaş hastalar
için) ve vücut kitle indeksi (≥5 yaş hastalar için) Z skoru -2 standart sapma
değerinden düşük olan 16 hasta (%25) vardı ve orta derecede malnutre olan bu
olguların tedavi bitiminde de aynı kaldığı görüldü. Hem kesin hem olası
tüberküloz grubunda tanı anındaki ve tedavi bitimindeki antropometrik ölçümler
arasında istatistiksel olarak anlamlı fark yoktu (p>0,05).



Sonuç: Pediatrik tüberküloz hastalarının nutrisyon
durumlarının izlenmesi, antitüberküloz tedavi ile birlikte beslenme
eksikliklerinin ve hatalarının giderilmesi ihmal edilebilmektedir. Çocuklarda
tüberküloz yönetimi ile malnutrisyon izlemi bütünleştirilmelidir

References

  • Global Tuberculosis Report 2017. Geneva, World Health Organisation, 2017, http://www.who.int/tb/publications/global_report/en/.
  • Kocabas E. Childhood tuberculosis. In: Ozlu T, Ozcelik U, Koksallar I, ed. Respiratory Tract Infections in Adults and Children. Istanbul, Nobel Publishers; 2014: 459-76.
  • Lönnroth K, Castro KG, Chakaya JM, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet 2010; 375: 1814–29.
  • Reference Book for Tuberculosis Control in Turkey, The Republic of Turkey Ministiry of Health, Department of Tuberculosis Control, Ankara, Turkey, http://www.verem.org.tr//kitap.php.
  • Diagnosis of TB in Children, Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children, World Health Organisation, Geneva, Switzerland, 2014, http://apps.who.int/medicinedocs/documents/s21535en/s21535en.pdf.
  • Salazar GE, Schemilz TL, Cama R, et al; Working Group on TB in Peru. Pulmonary tuberculosis in children in a developing country. Pediatrics 2001; 108: 448-53.
  • Kasapkara CS. Protein Energy Malnutrition. In: Yurdakok M, ed. Yurdakok Pediatrics. Ankara, Gunes Medical Publishers; 2017: 505-15.
  • Tuberculosis Control in Turkey Report 2015. Ankara, The Republic of Turkey Ministiry of Health, Public Health Institution, 2016, http://tuberkuloz.thsk.saglik.gov.tr.
  • Gocmen A, Cengizlier R, Ozcelik U, Kiper N, Senuyar R. Childhood tuberculosis: a report of 2205 cases. Turkish Journal of Pediatrics 1997; 39: 149-58.
  • Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS. Childhood tuberculosis in the Kilimanjaro region: lessons from and the fort he TB programme. Tropical Medicine and International Health 2010; 15: 496-501.
  • Turel O, Kazancı S, Gonen I, Aydogmus C, Karaoglan E, Siraneci R. Paediatric tuberculosis at a referral hospital in Istanbul: analysis of 250 cases. BioMed Research International volume 2016, Article ID 6896279, 6 pages. http://dx.doi.org/10.1155/2016/6896279
  • Tanır G, Akın A, Aydemir C, Uner C, Ceyhan I. The diagnosis of definitive or probable tuberculosis and latent tuberculosis infection in children with suspected tuberculosis. Tuberculosis and Thorax 2005; 53: 259-64.
  • Singer-Leshinsky S. Pulmonary tuberculosis. Improving diagnosis and management. JAAPA 2016; 29: 20-5.
  • Del-Castillo-Barrientos H, Centeno-Luque G, Untiveros-Tello A, et al. Clinical presentation of children with pulmonary tuberculosis: 25 years of experience in Lima, Peru. Int J Tuber Lung Dis. 2014; 18: 1066-73.
  • Esposito S, Tagliabue C, Bosis S. Tuberculosis in children. Mediterranean Journal of Hematology and Infectious Diseases 2013, vol 5, Article ID e2013064.
  • Pekcan S, Aslan AT, Kiper N, et al. Multicentric analysis of childhood tuberculosis in Turkey. Turk J Pediatr 2013; 55: 121-9.
  • Buonsenso D, Lancella L, Delogu G, et al. A twenty-year retrospective study of pediatric tuberculosis in two tertiary hospitals in Rome. Pediatric Infectious Disease Journal 2012; 31: 1022-6.
  • Wu XR, Yin QQ, Jiao AX, et al. Pediatric tuberculosis at Beijing Children’s Hospital: 2002-2010. Pediatrics 2012; 130: 433-40.
  • Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculosis meningitis and miliary tuberculosis worldwide: a metaanalysis and assessment of costeffectiveness. Lancet 2006; 367: 1173-80.
  • Gencer H, Dalgıc N, Kafadar I, Kabakcı D, Oncul U. Retrospective evaluation of 35 pediatric tuberculosis cases proven by histopathological and/or microbiological analysis. J Pediatr Inf 2015; 9: 97-101.
  • Shrestha S, Bichha RP, Sharma A, Upadhyay S, Rijal P. Clinical profile of tuberculosis in children. Nepal Med Coll J 2011; 13: 119-22.
  • Starke JR. Tuberculosis. In: Kliegman RM, Stanton BF, St.Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics 19th Edition. Elsevier; 2015: 996-1011.
  • Prapruttam D, Hedgire SS, Mani SE, Chandramohan A, Shyamkumar NK, Harisinghani M. Tuberculosis the great mimicker. Semin Ultrasound CTI MRI. 2014; 35: 195-214.
  • Sanai FM, Bzeizi KI. Systematic review: tuberculosis peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005; 22: 685-700.
  • Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009; 49: 1350- 7.
  • American Academy of Pediatrics. Tuberculosis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. American Academy of Pediatrics, Elk Grove Village, IL 2015. p.805.
  • Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005; 365:130-4.
  • Starke JR. Pediatric tuberculosis: time for a new approach. Tuberculosis 2003; 83: 208-12.
  • Pavan Kumar N, Anuradha R, Andrade BB, et al. Circulating biomarkers of pulmonary and extrapulmonary tuberculosis in children. Clin Vaccine Immunol 2013; 20:704-11.
  • Mexitalia M, Dewi YO, Pramono A, Anam MS. Effect of tuberculosis treatment on leptin levels, weight gain, and percentage body fat in Indonesian children. Korean J Pediatr 2017; 60:118-23.

Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators

Year 2019, Volume: 19 Issue: 1, 96 - 107, 22.03.2019
https://doi.org/10.17098/amj.542155

Abstract

Objectives: Pediatric tuberculosis is a
major public health problem. Malnutrition characterized with wasting is
prevalent among pediatric tuberculosis patients. We aimed to review pediatric
tuberculosis cases by considering their nutrition manifestations. 

Materials and Methods: The study
evaluated demographical, clinical, anthropometric, microbiological,
histopathological and radiological characteristics of tuberculosis patients,
retrospectively. 

Results: The study involved 77
tuberculosis cases. Sixty-three percent of the patients were male with a mean
age of 9.32±4.91 years. Twenty-four patients (31%) diagnosed with definite
tuberculosis, thirty-nine patients (50%) with probable tuberculosis, and
fourteen patients (18%) with latent tuberculosis infection. Acid resistant
bacteria were observed in 33%, culture positivity was observed in 20%, both
acid resistant bacteria and culture positivity was observed in 45% of definite
diagnosed group. Forty percent of patients had pulmonary, 32% had
extrapulmonary, 6% had miliary, 2% had both pulmonary and extrapulmonary
tuberculosis. Pulmonary tuberculosis diagnosed patients were significantly
older than extrapulmonary plus miliary group (p=0.003). Culture positivity rate
was significantly higher in pulmonary, diagnostic histopathological sampling
rate was significantly higher in extrapulmonary plus miliary group (p=0.019,
p=0.012). Thirty seven percent of patients had a contact history, 23% of those
had household contact, and the most common index cases were fathers. The
tuberculin test was positive in 11 patients (45%) with definite and 15 patients
(38%) with probable tuberculosis. No significant difference has been observed
between definite and probable tuberculosis groups according to the sex, average
age, symptom duration, tuberculin test positivity, Bacille Calmette-Guerin
vaccine scar presence, contact history rate, hematologic tests, and
anthropometric measurements (p>0.05). At the time of diagnosis mean (SD)
values of height for age and weight for height medians [ 94.35 (7.50) % and
85.72 (6.92) %, respectively] refered to mild malnutrition, the same conditions
were remaining at the end of treatment. When height for age taken into
consideration the chronic malnutrated group was probable tuberculosis group.
Weight for height (for <5 years old cases) and body mass index (for ≥5 years
old cases) Z scores of sixteen patients were less than -2 SD value and these
moderae malnutrated cases were remaining at the end of treatment. There was not
a statistical significance between anthropometric measurements at the time of
diagnosis and at the end of antituberculosis treatment (p>0.05). 

Conclusion: Nutrition status
monitoring, correcting nutritional deficiencies and failures can be neglected
in course of antituberculosis treatment. Tuberculosis management should be
integrated with malnutrition monitoring in pediatric cases. 

References

  • Global Tuberculosis Report 2017. Geneva, World Health Organisation, 2017, http://www.who.int/tb/publications/global_report/en/.
  • Kocabas E. Childhood tuberculosis. In: Ozlu T, Ozcelik U, Koksallar I, ed. Respiratory Tract Infections in Adults and Children. Istanbul, Nobel Publishers; 2014: 459-76.
  • Lönnroth K, Castro KG, Chakaya JM, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet 2010; 375: 1814–29.
  • Reference Book for Tuberculosis Control in Turkey, The Republic of Turkey Ministiry of Health, Department of Tuberculosis Control, Ankara, Turkey, http://www.verem.org.tr//kitap.php.
  • Diagnosis of TB in Children, Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children, World Health Organisation, Geneva, Switzerland, 2014, http://apps.who.int/medicinedocs/documents/s21535en/s21535en.pdf.
  • Salazar GE, Schemilz TL, Cama R, et al; Working Group on TB in Peru. Pulmonary tuberculosis in children in a developing country. Pediatrics 2001; 108: 448-53.
  • Kasapkara CS. Protein Energy Malnutrition. In: Yurdakok M, ed. Yurdakok Pediatrics. Ankara, Gunes Medical Publishers; 2017: 505-15.
  • Tuberculosis Control in Turkey Report 2015. Ankara, The Republic of Turkey Ministiry of Health, Public Health Institution, 2016, http://tuberkuloz.thsk.saglik.gov.tr.
  • Gocmen A, Cengizlier R, Ozcelik U, Kiper N, Senuyar R. Childhood tuberculosis: a report of 2205 cases. Turkish Journal of Pediatrics 1997; 39: 149-58.
  • Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS. Childhood tuberculosis in the Kilimanjaro region: lessons from and the fort he TB programme. Tropical Medicine and International Health 2010; 15: 496-501.
  • Turel O, Kazancı S, Gonen I, Aydogmus C, Karaoglan E, Siraneci R. Paediatric tuberculosis at a referral hospital in Istanbul: analysis of 250 cases. BioMed Research International volume 2016, Article ID 6896279, 6 pages. http://dx.doi.org/10.1155/2016/6896279
  • Tanır G, Akın A, Aydemir C, Uner C, Ceyhan I. The diagnosis of definitive or probable tuberculosis and latent tuberculosis infection in children with suspected tuberculosis. Tuberculosis and Thorax 2005; 53: 259-64.
  • Singer-Leshinsky S. Pulmonary tuberculosis. Improving diagnosis and management. JAAPA 2016; 29: 20-5.
  • Del-Castillo-Barrientos H, Centeno-Luque G, Untiveros-Tello A, et al. Clinical presentation of children with pulmonary tuberculosis: 25 years of experience in Lima, Peru. Int J Tuber Lung Dis. 2014; 18: 1066-73.
  • Esposito S, Tagliabue C, Bosis S. Tuberculosis in children. Mediterranean Journal of Hematology and Infectious Diseases 2013, vol 5, Article ID e2013064.
  • Pekcan S, Aslan AT, Kiper N, et al. Multicentric analysis of childhood tuberculosis in Turkey. Turk J Pediatr 2013; 55: 121-9.
  • Buonsenso D, Lancella L, Delogu G, et al. A twenty-year retrospective study of pediatric tuberculosis in two tertiary hospitals in Rome. Pediatric Infectious Disease Journal 2012; 31: 1022-6.
  • Wu XR, Yin QQ, Jiao AX, et al. Pediatric tuberculosis at Beijing Children’s Hospital: 2002-2010. Pediatrics 2012; 130: 433-40.
  • Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculosis meningitis and miliary tuberculosis worldwide: a metaanalysis and assessment of costeffectiveness. Lancet 2006; 367: 1173-80.
  • Gencer H, Dalgıc N, Kafadar I, Kabakcı D, Oncul U. Retrospective evaluation of 35 pediatric tuberculosis cases proven by histopathological and/or microbiological analysis. J Pediatr Inf 2015; 9: 97-101.
  • Shrestha S, Bichha RP, Sharma A, Upadhyay S, Rijal P. Clinical profile of tuberculosis in children. Nepal Med Coll J 2011; 13: 119-22.
  • Starke JR. Tuberculosis. In: Kliegman RM, Stanton BF, St.Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics 19th Edition. Elsevier; 2015: 996-1011.
  • Prapruttam D, Hedgire SS, Mani SE, Chandramohan A, Shyamkumar NK, Harisinghani M. Tuberculosis the great mimicker. Semin Ultrasound CTI MRI. 2014; 35: 195-214.
  • Sanai FM, Bzeizi KI. Systematic review: tuberculosis peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005; 22: 685-700.
  • Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009; 49: 1350- 7.
  • American Academy of Pediatrics. Tuberculosis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. American Academy of Pediatrics, Elk Grove Village, IL 2015. p.805.
  • Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005; 365:130-4.
  • Starke JR. Pediatric tuberculosis: time for a new approach. Tuberculosis 2003; 83: 208-12.
  • Pavan Kumar N, Anuradha R, Andrade BB, et al. Circulating biomarkers of pulmonary and extrapulmonary tuberculosis in children. Clin Vaccine Immunol 2013; 20:704-11.
  • Mexitalia M, Dewi YO, Pramono A, Anam MS. Effect of tuberculosis treatment on leptin levels, weight gain, and percentage body fat in Indonesian children. Korean J Pediatr 2017; 60:118-23.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Özlem Tezol 0000-0001-9994-7832

Mehmet Alakaya This is me

Asuman Akar This is me

Necdet Kuyucu This is me

Publication Date March 22, 2019
Published in Issue Year 2019 Volume: 19 Issue: 1

Cite

APA Tezol, Ö., Alakaya, M., Akar, A., Kuyucu, N. (2019). Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Medical Journal, 19(1), 96-107. https://doi.org/10.17098/amj.542155
AMA Tezol Ö, Alakaya M, Akar A, Kuyucu N. Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Med J. March 2019;19(1):96-107. doi:10.17098/amj.542155
Chicago Tezol, Özlem, Mehmet Alakaya, Asuman Akar, and Necdet Kuyucu. “Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators”. Ankara Medical Journal 19, no. 1 (March 2019): 96-107. https://doi.org/10.17098/amj.542155.
EndNote Tezol Ö, Alakaya M, Akar A, Kuyucu N (March 1, 2019) Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Medical Journal 19 1 96–107.
IEEE Ö. Tezol, M. Alakaya, A. Akar, and N. Kuyucu, “Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators”, Ankara Med J, vol. 19, no. 1, pp. 96–107, 2019, doi: 10.17098/amj.542155.
ISNAD Tezol, Özlem et al. “Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators”. Ankara Medical Journal 19/1 (March 2019), 96-107. https://doi.org/10.17098/amj.542155.
JAMA Tezol Ö, Alakaya M, Akar A, Kuyucu N. Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Med J. 2019;19:96–107.
MLA Tezol, Özlem et al. “Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators”. Ankara Medical Journal, vol. 19, no. 1, 2019, pp. 96-107, doi:10.17098/amj.542155.
Vancouver Tezol Ö, Alakaya M, Akar A, Kuyucu N. Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Med J. 2019;19(1):96-107.