C Jacobs1, P Goussard1, R P Gie1. 1. Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Abstract
SETTING: Tertiary care hospital, Western Cape, South Africa. DESIGN: Retrospective descriptive study of a case series of necrotising pneumonia (NP) in children associated with Mycobacterium tuberculosis presenting over a 4-year period in a country with high human immunodeficiency virus (HIV) and tuberculosis (TB) prevalence. OBJECTIVE: To describe the clinical and radiological features of, and treatment regimens and outcomes in, children with NP. RESULTS: Of 32 children (median age 16.5 months, interquartile range 10-33), 8 (25%) (median age 49 months) had NP associated with M. tuberculosis, 6 of whom were HIV-infected. Chest computed tomography (CT) was diagnostic in all cases: no radiological signs were suggestive of TB. There was no difference in the clinical picture, chest radiography or CT scan between M. tuberculosis-associated and bacterial NP. M. tuberculosis was cultured in 75% of cases; pleural fluid acid-fast bacilli was positive in an additional two cases. Surgery was required in 46% of the M. tuberculosis cases. At follow-up, 50% of these cases had complete radiological resolution similar to bacterial NP. CONCLUSION: This series highlights the fact that M. tuberculosis not only causes acute pneumonia in children, it also results in numerous complications. M. tuberculosis should be considered as a cause of NP in all children, especially HIV-infected children, living in high TB prevalence regions.
SETTING: Tertiary care hospital, Western Cape, South Africa. DESIGN: Retrospective descriptive study of a case series of necrotising pneumonia (NP) in children associated with Mycobacterium tuberculosis presenting over a 4-year period in a country with high human immunodeficiency virus (HIV) and tuberculosis (TB) prevalence. OBJECTIVE: To describe the clinical and radiological features of, and treatment regimens and outcomes in, children with NP. RESULTS: Of 32 children (median age 16.5 months, interquartile range 10-33), 8 (25%) (median age 49 months) had NP associated with M. tuberculosis, 6 of whom were HIV-infected. Chest computed tomography (CT) was diagnostic in all cases: no radiological signs were suggestive of TB. There was no difference in the clinical picture, chest radiography or CT scan between M. tuberculosis-associated and bacterial NP. M. tuberculosis was cultured in 75% of cases; pleural fluid acid-fast bacilli was positive in an additional two cases. Surgery was required in 46% of the M. tuberculosis cases. At follow-up, 50% of these cases had complete radiological resolution similar to bacterial NP. CONCLUSION: This series highlights the fact that M. tuberculosis not only causes acute pneumonia in children, it also results in numerous complications. M. tuberculosis should be considered as a cause of NP in all children, especially HIV-infectedchildren, living in high TB prevalence regions.