Background:

Childhood tuberculosis (TB) is a health problem because it accounts for 10% of TB cases worldwide. Despite the usage of medical practice guidelines for children with suspected TB, diagnosis is difficult due to its paucibacillary nature, the diverse clinical presentation and the available microbiologic and immunologic diagnostic tests.

Material and methods:

We reviewed the clinical records of pediatric patients hospitalized at INER during 2015-2017 period with diagnosis of TB, analyzing the demographic data, BCG vaccination, clinical chart; the results of laboratory, immunological and specific diagnostic tests for M. tuberculosis, and the therapeutic choice.

Results:

We described data from 22 patients, with a mean age of 7.3 ± 4.7 years and a male: female ratio of 1:1.2. All patients lived in Mexico City and its adjoining area; 63.6% of children were vaccinated with BCG, 59.1% were in contact with a TB adult patient, and 13.6% had an underlying disease. The most frequent clinical symptoms were cough, fever and weight loss. Laboratory data were normal in most cases. TB culture was positive in 59.1% of cases, baciloscopy in 27.8% of cases and molecular biology in 36.8% of cases. Regarding the immunological analyses, the tuberculin skin test (TST) was positive in 68.8%, while interferon gamma release assays (IGRA) were only performed in two cases. The most frequent clinical presentation was pulmonary TB (63.6% of cases). TB treatment was offered in 81.8% of cases; two patients were treated with second-line drugs due to contact with multidrug-resistant TB (MDR-TB), regardless of TB microbiological confirmation. Not all TB diagnostic tests available or routine immunological screening were performed in all patients, due to sample restriction or practitioner judgement.

Conclusions:

More clinical research studies are needed to improve the diagnosis of childhood TB and to support an adequate therapeutic decision for each patient. In this paper, we propose an algorithm for evaluating pediatric patients with suspected TB.