Characteristics Of Smear Positive Pulmonary Tuberculosis In Infants
Dr. Manikumar*, Dr. Vijayasekaran**, Dr. Gowrishankar***, Dr. Vidhya Krishna****, Dr. Sethuraman*****, Dr. Mallika Pathmanabhan******
Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. *, Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. **, Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. ***, Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. ****, Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. *****, Dept of Pulmonology, Institute of Child Health Hospital for Children, Chennai. ******
Introduction
Tuberculosis in children is an important problem especially in countries like India where adult tuberculosis is common. There are 30 million cases of active tuberculosis in the world, 10 million new cases occur annually and 3 million people die of tuberculosis each year. Global estimates of 1.5 million new cases and 130,000 deaths due to TB per year amongst children is reported. The implementation of RNTCP in the pediatric population should be taken as the priority by all those who are interested in the welfare of pediatric population. From a survey of RNTCP implementing districts, pediatric cases were seen to make up 3% of the total load of new cases registered under RNTCP. After the inception of RNTCP cell in Institute of Child Health and Hospital for Children, (Nov 2004), the identification of smear positivity in specimens are steadily increasing, even in infants. Hough the epidemiological characteristics of tuberculosis in children were studied, there are hardly few studies in infants with pulmonary tuberculosis. Thrilled by the smear positivity, this study has been conducted to analyze the characteristics of smear positive infants.
Aim
To study the clinico-epidemiological and radiological characteristics of smear positive pulmonary tuberculosis in infants and the outcome.
Subjects & Methods
Study design: Prospective follow-up study Setting: Department of pulmonology, Institute of Child Health and Hospital for Children, Chennai.

Study period: Nov 2004 to June 2006

Study population: Infants with pulmonary tuberculosis.

Manoeuvre: Of the 317 infants who were registered under RNTCP as pulmonary tuberculosis, 32 (10.1%) were found to be smear positive in gastric lavage or BAL. Those infants with smear positivity (at least one of the three smears), from gastric aspirate or BAL, taken on 3 consecutive days, positive for acid fast bacilli (AFB) were prospectively studied and their clinico-epidemiological characters, radiological lesions and outcome were analyzed.
Results
Of the 32 infants, 20 (63%) were males. Acute presentation is seen in 5 (16%) cases. Undernutrition was present in 29 (91%) cases, which is mild (Grades 1 & 2) in 15, and severe (Grades 3 & 4) in 14. A contact history could be elicited in 11 (34%) cases. Routine parental screening detected 5 (16%) case and a BCG scar was seen in 17 (53%) cases. Bad child rearing practices (nose blowing or oil insufflation) was surprisingly seen in 24 (75%) cases. HIV ELISA was negative in all. Skiagram demonstrated pneumonia in 7 (22%), extensive bronchopneumonia in 22 (69%), cavitory lesion in 1 (3.1%) and was normal in 2 (6.2%). Of the 15 cases subjected to Fiber optic bronchoscopy, intrabronchial lesions suggestive of endobronchial tuberculosis were seen in 9 (28%) cases. 4 (12%) cases showed disseminated tuberculosis.
Conclusion
Smear examination plays a major role in the diagnosis of pulmonary tuberculosis in infants also (10.1%). Bad child rearing practices plays an important role in the transmission in infants with pulmonary tuberculosis. Fiber optic bronchoscopy contributes significantly to the final diagnosis (28).
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Manikumar D, Vijayasekaran D, Gowrishankar D, Krishna V D, Sethuraman D, Pathmanabhan M D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=370
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