Miliary tuberculosis in children: a review of 94 cases.
This is a retrospective review of the clinical, radiologic and laboratory features of 94 cases of childhood miliary tuberculosis seen during a 5-year period, 1985 to 1989. A history of Bacillus Calmette-Guérin vaccination was documented in 88% of children. The median age at presentation was 10.5 months, 52% of cases occurring in those younger than 1 year. The presenting symptoms were nonspecific: cough (72%); fever (61%); loss of appetite and weight (40%); and diarrhea and vomiting (33%). The main presenting signs were hepatomegaly (82%), splenomegaly (54%), lymphadenopathy (46%) and pyrexia (39%). Most of the patients were malnourished and anergic. Meningitis occurred in 19% of patients and this was the only significant risk factor identified for mortality, the overall case fatality rate being 14%. The diagnosis in the vast majority was made on the clinical presentation supported by a classic miliary pattern on chest roentgenogram (91% of cases). Mycobacterium tuberculosis was cultured in 33% of cases. In addition a review of hospital admissions from 1981 to 1989 revealed that annually miliary tuberculosis in children and adults accounted for 8.3 and 1.3%, respectively, of all tuberculosis admissions. This study confirms that miliary tuberculosis is a relatively common complication of tuberculosis in young children.
Hussey
G
G
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Chisholm
T
T
Kibel
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001500:BCG Vaccine; D002648:Child; D002675:Child, Preschool; D015981:Epidemiologic Factors; D005260:Female; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D014390:Tuberculosis, Meningeal / Q000453:epidemiology; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D001500:BCG Vaccine