Evaluation of Tuberculous Pulmonary Segmental Lesions in Children with Emphasis on Refractory Segmental Lesions and Its Response to Modified Anti Tuberculosis Therapy

Abstract

Tuberculosis in children is an important disease because of higher incidence and mortality, especially in developing and under developed countries. Its prevalance is universal and may manifest as different forms of tuberculosis at all ages. It is important that infected children are diagnosed and treated, as those with untreated or inadequately treated primary infection may still become new cases of tuberculosis if their disease reactivated during adult life. OBJECTIVES: 1. To evaluate tuberculous pulmonary segmental lesions with emphasis on refractory segmental lesions and its response to modified antituberculosis therapy in children. 2. To assess the efficacy of modified antituberculosis therapy in refractory pulmonary lesions that are referred to the Institute of Child Health from various institutions. Tuberculous pulmonary segmental lesions were common in younger age group (64.1%), increasingly reported at tertiary care Institutions like ICH and HC. Sixty six percent of the study population showed BCG scar stating that BCG vaccination did not lower the incidence of intrathoracic tuberculosis. CONCLUSIONS: The evaluation of tuberculous pulmonary segmental lesions in childhood population revealed the following facts : i) Common in younger age group (64.1%), ii) 66% of lesions occurred in children with BCG scar, iii) 51.4% with positive Mantoux, iv) 54.5% with adult contact, v) Cough as the predominant symptom (58.5%), vi) 42.7% of lesion in the right lung, vii) Bacteriological proof in 16.3%, viii) Bronchial abnormalities in 30% in children who were brochoscopically evaluated. ix) 57.5% of the study population radiologically cleared after recommended antituberculosis therapy. Modified antituberculous therapy had cleared 47% of the refractory segmental lesions who otherwise would have been subjected for surgical intervention and there were no adverse reactions, the modified ATT can be safely be recommended in children with refractory pulmonary segmental lesions. newline