Published online Nov 8, 2013. doi: 10.5409/wjcp.v2.i4.70
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.
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.