title: Paradoxical reaction in immunocompetent children with tuberculosis.
abstract: BACKGROUND
  A paradoxical reaction (PR) during anti-tuberculosis treatment is a phenomenon that is poorly studied in immunocompetent children. It is defined as a clinical or radiological worsening of pre-existing tuberculosis (TB) disease.
  
  
  METHODS
  A retrospective descriptive study of children younger than 14 years of age was performed; these children developed PR during the years 2009 to 2014, following a diagnosis of TB. Demographic characteristics, microbiological results, treatment and outcome data were collected.
  
  
  RESULTS
  Of 51 children diagnosed with TB, five (9.8%) developed a PR; four of these children had pulmonary TB and the remaining patient had miliary TB with central nervous system involvement. The PR occurred at a median of 42 days (range 23-53 days) after initiating therapy. Corticosteroids were started when PR was suspected, at a median dose of 1mg/kg/day. Clinical and radiological improvement was noted in all cases, with a median clinical regression time of 10.5 days (range 3-15 days) and a median radiological regression time of 45 days (range 26-105 days). No sequelae were described in any patient.
  
  
  CONCLUSIONS
  PR in immunocompetent children during anti-tuberculosis treatment is not such an unusual reaction. Treatment with corticosteroids may be useful for the resolution of PR.
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain. Electronic address: bcarazo002@gmail.com.
authors.forename: Begoña
authors.initials: B
authors.lastname: Carazo Gallego
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Pérez
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Nuñez Cuadros
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Mesa Fernandez
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Martin Cantero
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Obando Pacheco
authors.affiliation: Infectious Diseases and Immunodeficiencies Unit, Department of Paediatrics, Malaga Regional University Hospital, Avenida Arroyo de los Angeles, s/n, Malaga, 29011, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Urda Cardona
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy* / Q000503:physiopathology; D014391:Tuberculosis, Miliary / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000382:microbiology
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents
keywords: Children; Corticosteroids; Immunocompetent; Paradoxical reaction; Tuberculosis