Childhood pleural tuberculosis: a review of 45 cases.
BACKGROUND
Pleural tuberculosis (TB) can be seen in isolation or complicate untreated pulmonary disease in children. It is infrequently suspected in low incidence countries, leading to delays in diagnosis and treatment.


METHODS
This was a retrospective descriptive case series of children<or=18 years old with pleural TB seen in a referral clinic in Houston, Texas from 1984 to 2008. Medical record data, radiographs, and health department records were reviewed. Epidemiologic, clinical, radiographic, and microbiologic findings are described.


RESULTS
Forty-five children (mean age 10.9 years) were diagnosed with TB. Contacts with cases of infectious tuberculosis were identified for 20 children (44%). Positive tuberculin skin tests were seen in 89%. Seventy-three percent of children had concomitant pulmonary parenchymal disease or intrathoracic lymphadenopathy. Cultures were attempted in 40 of 45 children (89%). No patient had acid-fast bacillus smear-positive pleural fluid, but pleural fluid cultures were positive in 56%. Cultures from other respiratory sources were positive in 48% of patients. Although all patients had symptomatic resolution and radiographic improvement, chest radiographs were improved but abnormal in 62% of patients at the end of therapy. No child developed relapse or recrudescence after therapy was discontinued.


CONCLUSIONS
Pleural TB was usually associated with a positive tuberculin skin test, and lung parenchymal infiltrates were seen commonly. All children had symptomatic resolution and radiographic improvement, and 6-month courses of therapy resulted in disease resolution for children with isolated pleural or pleural and pulmonary parenchymal disease.
Cruz
Andrea T
AT
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. acruz@bcm.edu
Ong
Lydia T
LT
Starke
Jeffrey R
JR
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014374:Tuberculin Test; D014396:Tuberculosis, Pleural / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology
D000995:Antitubercular Agents