Background and aims Tuberculosis is among the top 10 causes of child death worldwide. We aimed to describe epidemiological, clinical and microbiological features of patients with active tuberculosis admitted in two tertiary hospitals in Rome.
Methods Retrospective study of patients < 16-year-old evaluated between 1990 and 2009.
Results 214 cases of active tuberculosis were identified (132 definite, 82 probable). Pulmonary involvement was the most common form (75.5%), followed by lymphadenopathy (15.4%) and central nervous system tuberculosis (11%). Fever (51.86%) and cough (40%) were the most common presenting symptoms. 23.4% children were asymptomatic on admission. Sensitivities for Tuberculin Skin Test and Quantiferon test were 93.4% and 97% respectively. Both tests were performed in 52 children agreeing in 49 cases (94%). Sensitivities for culture, Ziehl-Neelsen staining and polymerase chain reaction were 58%, 25% and 66.3% respectively. The adult source case was identified in 28% cases. History of contact with a patient with active tuberculosis was associated with pulmonary tuberculosis (P=0.0014), while negative history of contact was associated with lymph nodal (P=0.0064) and central nervous system tuberculosis (P=0.05).
Conclusions Our study emphasize the difficulty in managing children with suspected tuberculosis, since the absence of constitutional symptoms cannot exclude tuberculosis and bacteriological confirmation is the exception. Immunological diagnosis can be valuable tool to identify tuberculosis infected children since quantiferon showed high sensitivity in all age-groups; this is of primary importance since early identification of children with latent tuberculosis infection and appropriate chemoprophylaxis represent the most important tool to reduce tuberculosis burden.