Childhood tuberculosis in southern Taiwan, with emphasis on central nervous system complications.
OBJECTIVE
Childhood tuberculosis (TB) continues to be a major public health problem in Taiwan. Taiwan remains a highly endemic area despite neonatal Bacillus Calmette-Guérin (BCG) vaccination and the availability of anti-TB therapy. The presentation is highly variable and it is often difficult to make an accurate diagnosis. This study was designed to evaluate the demographic, clinical, and laboratory findings and outcomes of TB in children with emphasis on central nervous system (CNS) complications.


METHODS
The medical records of 80 children diagnosed with TB at a medical center in southern Taiwan over the past 24 years (1988-2012) were reviewed.


RESULTS
Among them, 48.8% (39/80) had pulmonary TB, 27.5% (22/80) had isolated extrapulmonary TB, and 23.7% (19/80) had disseminated TB. Most infected cases were aged either < 4 years or > 12 years. TB contact history was found in 42.5% (34/80) cases. Fourteen (17.5%) of the cases had CNS involvement. The most common presentations were fever (85.7%), signs of increased intracranial pressure (71.4%), drowsiness (64.3%), and focal neurological signs (57.1%). The major radiological findings were tuberculoma (50%), basilar enhancement (41.6%), infarction (41.6%), hydrocephalus (16.6%), and transverse myelitis (16.6%). The case fatality of CNS TB was 14.3% and 21.4% had neurologic sequelae.


CONCLUSIONS
Findings suggest that positive exposure history and suspicious clinical presentations are important clues for further confirmatory laboratory and image studies in childhood TB. CNS TB usually presented as part of disseminated TB in children. Early diagnosis and treatment may lead to favorable outcomes in CNS TB.
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Yu-Hao
YH
Cho
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Diseases and Signaling Research, National Cheng Kung University, Tainan City, Taiwan.
Tzong-Shiann
TS
Ho
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Diseases and Signaling Research, National Cheng Kung University, Tainan City, Taiwan.
Shih-Min
SM
Wang
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Diseases and Signaling Research, National Cheng Kung University, Tainan City, Taiwan.
Ching-Fen
CF
Shen
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Po-Kai
PK
Chuang
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Diseases and Signaling Research, National Cheng Kung University, Tainan City, Taiwan. Electronic address: liucc@mail.ncku.edu.tw.
Ching-Chuan
CC
Liu
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009026:Mortality; D013624:Taiwan / Q000453:epidemiology; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*
Central nervous system; Childhood; Meningitis; Mycobacterial infection; Tuberculosis