Brief Article
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World J Clin Pediatr. Nov 8, 2013; 2(4): 70-76
Published online Nov 8, 2013. doi: 10.5409/wjcp.v2.i4.70
Pediatric vs adult pulmonary tuberculosis: A retrospective computed tomography study
Prasad Thotton Veedu, Ashu Seith Bhalla, Sreenivas Vishnubhatla, Sushil Kumar Kabra, Arundeep Arora, Divya Singh, Arun Kumar Gupta
Prasad Thotton Veedu, Ashu Seith Bhalla, Arundeep Arora, Divya Singh, Arun Kumar Gupta, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
Sreenivas Vishnubhatla, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
Sushil Kumar Kabra, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Thotton Veedu P, Bhalla AS and Gupta AK were responsible for performing the radiological investigation and involved in image and data analysis; Kabra SK performed the clinical evaluation of the patients; Vishnubhatla S performed the statistical analysis; Arora A and Singh D were involved in analysis of imaging and manuscript preparation.
Correspondence to: Ashu Seith Bhalla, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Telephone: +91-11-265949258 Fax: +91-11-26588641
Received: July 28, 2013
Revised: September 25, 2013
Accepted: October 15, 2013
Published online: November 8, 2013

AIM: To compare the manifestations of chest tuberculosis (TB) in pediatric and adult patients based on contrast enhanced computed tomography of chest.

METHODS: This was a retrospective study consisting of 152 patients of chest TB including 48 children and 104 adults who had undergone contrast enhanced computed tomography of chest prior to treatment. The patterns and severity of parenchymal, mediastinal and pleural manifestations were analyzed and compared among different age groups.

RESULTS: Parenchymal changes observed include consolidation, air space nodules, miliary TB, cavitation, bronchiectasis and fibrosis and these were noted in 60% of children, 71% of adolescents and 76.9% of adults. These changes were more common in right upper lobe in all age groups. There was no significant difference in the frequency of these changes (except nodules) in different age groups. Centrilobular nodules were seen less commonly in children less than 10 years (P = 0.028). Pleural effusion was noted in 28 (18.42%) patients and pericardial effusion in 8 (5.3%) patients. No significant difference in the serosal involvement is seen among children and adults. Mediastinal adenopathy was seen 70% of children, 76.3% adolescents and 76.9% of adults and paratracheal nodes were seen most frequently. Nodes had similar features (except matting) among all age groups. Matting of nodes was seen more commonly in children (P = 0.014).

CONCLUSION: Pediatric chest tuberculosis can have severe parenchymal lesions and nodal involvement similar to adults. The destructive lung changes observed in children needs immediate attention in view of the longer life span they have and hence in formulating optimal treatment strategies.

Keywords: Tuberculosis, Pulmonary, Primary tuberculosis, Children, Computed tomography

Core tip: Primary tuberculosis in children was traditionally thought to be distinct from reactivation tuberculosis in terms of location, pattern and severity. On the contrary, aggressive forms of pulmonary tuberculosis akin to adult forms are increasingly seen in pediatric clinical practice especially in adolescents. Our study revealed that similar to older patients, children with tuberculosis are equally prone to develop significant destructive lung changes with severe sequelae. Having longer life expectancy the impact is much more severe in children. Moreover, the cavitating lesions with high bacterial load make them highly infective and pose an important threat to community health.