title: Spectrum of Disease in Children Treated for Tuberculosis at a Tertiary Children's Hospital in Australia.
abstract: BACKGROUND
  Tuberculosis (TB) notification rates in Australia have plateaued at a low level, but the pediatric disease burden remains poorly described. Child cases provide a marker of recent transmission and present unique diagnostic challenges.
  
  
  METHODS
  We performed an audit of all children (<18 years of age) treated for TB at the Children's Hospital at Westmead, Sydney, Australia from January 2008 to December 2011. Demographics, clinical presentation, diagnostics, disease profile, treatment, and outcome were reviewed.
  
  
  RESULTS
  A total of 25 children were treated for TB: 15 had microbiologically confirmed TB; 7 were diagnosed on clinical grounds; and in 3, an alternate diagnosis was established (2 bacille Calmette-Guérin disease and 1 atypical mycobacterial infection). Of the 22 TB cases, 21 had a history of immigration or travel to a TB-endemic country and 4 reported recent contact with a TB source case within Australia. Isolated intrathoracic TB was documented in 16 (72%) cases. Symptoms on presentation included the following: lethargy, weakness, or malaise (75%); fever (73%); and cough (64%). Among the 15 children with microbiologically confirmed TB, 11 (73%) were positive by culture and 11 of 13 (85%) by polymerase chain reaction test. Tuberculin skin test was positive (≥10 mm) in 80% (16 of 20) of cases, and interferon-gamma release assay was positive in 87% (13 of 15) of cases. All children received directly observed therapy and recovered.
  
  
  CONCLUSIONS
  This series demonstrates the broad spectrum of disease with which pediatric TB cases present and the need for ongoing vigilance. A more comprehensive review of pediatric TB cases throughout Australia would be informative.
authors.affiliation: The Children's Hospital, Westmead, New South Wales Sydney Medical School, University of Sydney.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Britton
authors.affiliation: Sydney Medical School, University of Sydney.
authors.forename: Veronica
authors.initials: V
authors.lastname: Yeung
authors.affiliation: Communicable Diseases Branch, New South Wales Health, North Sydney, New South Wales.
authors.forename: Chris
authors.initials: C
authors.lastname: Lowbridge
authors.affiliation: The Children's Hospital, Westmead, New South Wales.
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
authors.affiliation: The Children's Hospital, Westmead, New South Wales Sydney Emerging Infectious Diseases and Biosecurity Institute, University of Sydney, Australia.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
keywords: Children; Diagnosis; Disease Spectrum; Treatment; Tuberculosis