PEDIATRICS Vol. 108 No. 2 August 2001, pp. 448-453
Pulmonary Tuberculosis in Children in a Developing Country
Received May 26, 1999; accepted Feb 27, 2001.
,, §,,
,
From the * University of Illinois at Chicago, Department of
Pediatrics, Chicago, Illinois; Objective. We evaluated the clinical
and epidemiologic characteristics of Peruvian children presenting with
pulmonary tuberculosis (PTB) to determine whether features predictive
of confirmed PTB could be identified.
Study Design. This was a cross-sectional study of 135 children (mean age: 6.8 years) presenting to the Hospital del
Niño in Lima, Peru, with presumptive diagnosis of PTB. Clinical,
epidemiologic, and laboratory findings were compared between 3 groups
of pediatric patients with a presumptive diagnosis of PTB: those with
positive Mycobacterium tuberculosis (MTB) cultures,
those likely to have PTB based on clinical criteria but with negative
cultures, and those who did not meet clinical diagnostic criteria or
have positive cultures.
Results. A total of 50 (37%) patients were diagnosed with
definitive PTB based on positive sputum culture. Another 55 (47%)
patients were classified as having probable PTB based on meeting at
least 2 of the following criteria: cough lasting for at least 2 weeks, typical chest radiograph changes, purified protein derivative (PPD)
Conclusions. The typical presentation of PTB in Peruvian
children includes symptoms of active pulmonary disease similar to those
seen in adults. This presentation differs significantly from that
reported in developed countries, where many children have minimal or no symptoms at the time of presentation. The diagnostic criteria for
pediatric PTB must be modified in hyperendemic developing country
environments where features may differ from those described in the
United States. The triad of cough lasting Asociación Benéfica
Proyectos en Informatica, Salud, Medicina, y Agricultura (PRISMA),
Lima, Peru; § Children's Hospital Medical Center, Seattle, Washington;
Department of Pathology, Universidad Peruana Cayetano Heredia, Lima,
Peru; ¶ Instituto de Salud del Niño, Lima, Peru; # Molecular
Immunogenetics Laboratory, Ochsner Medical Foundation, New Orleans,
Louisiana; ** Department of Tropical Medicine, Tulane School of Public
Health and Tropical Medicine, New Orleans, Louisiana; Department
of International Health, Johns Hopkins University School of Hygiene and
Public Health, Baltimore, Maryland; §§ Department of Family Medicine,
University of Washington, Seattle; and || The Working Group on TB in
Peru: Lidia Barreto, Marta Sandoval, Flor Salcedo, Eugenio Morales,
Maria Bances, Patricia Fuentes, Juan Jimenez, Lucy Caviedes, Patricia
Torres, Teresa Valencia, Monica Ruiz, and Rosa Chumpitaz.
10 mm, or history of tuberculosis family contact. Patients with
definitive or probable PTB were significantly older than patients
without clinical PTB, and those with symptomatic disease were
significantly older than those with asymptomatic disease. Patients with
PTB diagnosed by culture were significantly more likely than those
diagnosed using clinical criteria to have cough lasting 2 weeks,
fever, and a PPD 10 mm.
2 weeks, fever, and a PPD
10 mm was highly predictive for culture-positive PTB among children
in this low-income Peruvian population.
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