title: The spectrum of disease in children treated for tuberculosis in a highly endemic area.
abstract: BACKGROUND
  Children contribute a substantial proportion of the global tuberculosis (TB) caseload, particularly in endemic areas, where little is known about their spectrum of disease.
  
  
  OBJECTIVE
  To document the complete disease spectrum, with relevant age- and HIV-related differences, in children treated for TB in a highly endemic community.
  
  
  METHODS
  A prospective descriptive study was conducted from February 2003 to October 2004 at five primary health care clinics in Cape Town, South Africa, including all children (< 13 years of age) treated for TB.
  
  
  RESULTS
  In total, 439 children received anti-tuberculosis treatment. The spectrum of disease included 85 (19.4%) 'not TB', 307 (86.7%) intra-thoracic TB and 72 (20.3%) extra-thoracic TB (25 [5.7%] with co-existing intra- and extra-thoracic disease were included in both groups). In non-HIV-infected children, disseminated (miliary) disease (9/11, 81.8%) and tuberculous meningitis (TBM) (10/13, 76.9%) were predominantly documented in children < 3 years of age. In HIV-infected children, complicated Ghon focus and disseminated (miliary) disease were significantly more common (6/25, 24.0%) than in non-HIV-infected children (12/414, 2.9%) (OR 10.9, 95% CI 3.2-35.9).
  
  
  CONCLUSIONS
  This study describes the complete disease spectrum observed in children treated for TB in a highly endemic area. Children suffered significant morbidity, with most severe disease recorded in very young and/or HIV-infected children.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa. bjmarais@sun.ac.za
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.forename: A C
authors.initials: AC
authors.lastname: Hesseling
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.forename: N
authors.initials: N
authors.lastname: Beyers
mesh_terms: D015492:AIDS Serodiagnosis; D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*