Shakoor Sadia, Mir Fatima, Hasan Rumina
Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Int J Mycobacteriol. 2019 Jan-Mar;8(1):42-47. doi: 10.4103/ijmy.ijmy_8_19.
Children evaluated for tuberculosis (TB) are often diagnosed with miscellaneous conditions that mimic TB. Knowledge of differentials informs policy on service provision through liaison with referral centers offering definitive diagnosis and treatment for common alternative disorders.
We reviewed medical records of children who were offered diagnostic testing for TB (culture or Xpert MTB/RIF) at a tertiary care hospital in Karachi, Pakistan to identify common alternative diagnoses among children who are evaluated for TB.
From January 2014 to December 2015, of 126 culture or Xpert MTB/RIF negative children presenting with chronic symptoms, 31 were diagnosed and treated for TB based on clinical criteria (5 of 48 children with pulmonary and 26 of 78 with extrapulmonary presentations; 10.4% and 33.3%, respectively). Among remaining 95 patients, common alternative diagnoses to pulmonary TB (n = 43) were bacterial pneumonia or empyema (60.5%, n = 25) and underlying bronchiectasis (20.9%, n = 9). Among 52 extrapulmonary presentations, the most common alternative diagnoses were lymphoproliferative disorders (n = 11, 21.1%), bacterial infections (n = 11, 21.1%), and autoimmune disorders (n = 9, 17.3%). Of note, five children were diagnosed with underlying primary immunodeficiencies (9.6%). Children with alternative disorders were treated for TB in 25 of 95 cases (26.3%). Although 77.8% (n = 98) children were followed up at the facility, 15.9% (n = 20) were lost to follow-up.
Pediatric TB mimics many disorders that primary level centers are not equipped to diagnose or manage, leading to suboptimal outcomes. Knowledge of common alternative diagnoses is essential to inform facilitated referral for common mimicking disorders in children.
接受结核病（TB）评估的儿童常被诊断出患有多种类似结核病的病症。了解鉴别诊断有助于通过与为常见替代疾病提供明确诊断和治疗的转诊中心联络，制定服务提供政策。
我们回顾了在巴基斯坦卡拉奇一家三级护理医院接受结核病诊断检测（培养或Xpert MTB/RIF）的儿童的病历，以确定接受结核病评估的儿童中常见的替代诊断。
2014年1月至2015年12月，126名出现慢性症状且培养或Xpert MTB/RIF检测结果为阴性的儿童中，31名根据临床标准被诊断为结核病并接受治疗（48名肺部症状儿童中有5名，78名肺外症状儿童中有26名；分别为10.4%和33.3%）。在其余95名患者中，肺结核（n = 43）的常见替代诊断为细菌性肺炎或脓胸（60.5%，n = 25）和潜在支气管扩张（20.9%，n = 9）。在52例肺外症状中，最常见的替代诊断为淋巴增殖性疾病（n = 11，21.1%）、细菌感染（n = 11，21.1%）和自身免疫性疾病（n = 9，17.3%）。值得注意的是，5名儿童被诊断出患有潜在的原发性免疫缺陷（9.6%）。95例中有25例（26.3%）患有替代疾病的儿童接受了结核病治疗。虽然77.8%（n = 98）的儿童在该机构接受了随访，但15.9%（n = 20）失访）。
儿童结核病类似许多基层中心无能力诊断或管理的疾病，导致治疗效果欠佳。了解常见的替代诊断对于为儿童常见的类似疾病提供便利的转诊至关重要。
