title: Clinical presentation of children with pulmonary tuberculosis: 25 years of experience in Lima, Peru.
abstract: OBJECTIVE
  To describe clinical presentation across age groups in 2855 children with pulmonary tuberculosis (TB) attending the Children's Hospital, Lima, Peru, to improve the diagnosis, treatment and care of childhood TB.
  
  
  METHODS
  Children aged 0-14 years admitted between 1 January 1973 and 31 December 1997 with active pulmonary TB were enrolled. Demographic information, history, physical examination data, laboratory and microbiological results, chest radiograph data, disease classification, treatment and adverse effect data, and outcome at the time of discharge were recorded by pulmonologists using detailed chart abstractions.
  
  
  RESULTS
  Of the 2855 enrollees, 47% were malnourished and 56% had a household contact. Older children presented with classic TB symptoms, while weight loss and anorexia were rare in children aged <5 years. Microbiological or pathologic confirmation was obtained in 71% of children aged 10-14 years compared with 34% of children aged <2 years; however, severe extra-pulmonary TB was most common among children aged <2 years (41%).
  
  
  CONCLUSIONS
  Classic TB symptoms should be considered when making a diagnosis; however, systematic symptoms among young children are also important. In high-burden settings, clinicians should have a low threshold to diagnose and treat children for TB across all ages, even in the context of a negative tuberculin skin test result and lack of micro-pathological confirmation.
authors.affiliation: Servicio de Neumología, Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: H
authors.initials: H
authors.lastname: Del Castillo-Barrientos
authors.affiliation: Servicio de Neumología, Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: G
authors.initials: G
authors.lastname: Centeno-Luque
authors.affiliation: Servicio de Neumología, Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: A
authors.initials: A
authors.lastname: Untiveros-Tello
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: B
authors.initials: B
authors.lastname: Simms
authors.affiliation: Socios En Salud, Sucursal Peru, Lima, Peru.
authors.forename: L
authors.initials: L
authors.lastname: Lecca
authors.affiliation: Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Nelson
authors.affiliation: Boston Health Care for the Homeless, Somerville, Massachusetts, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lastimoso
authors.affiliation: Socios En Salud, Sucursal Peru, Lima, Peru.
authors.forename: S
authors.initials: S
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016358:Contact Tracing; D003906:Developing Countries; D005260:Female; D006798:Housing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009752:Nutritional Status; D010568:Peru / Q000453:epidemiology; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission
chemical_list: D000995:Antitubercular Agents