Hamdar Hussein, Nahle Ali Alakbar, Ataya Jamal, Jawad Ali, Salame Hadi, Jaber Rida, Kassir Mohammad, Wannous Hala
Faculty of Medicine, Damascus University, Damascus, Syria.
Faculty of Medicine, University of Aleppo, Syria.
Heliyon. 2024 Aug 23;10(17):e36779. doi: 10.1016/j.heliyon.2024.e36779. eCollection 2024 Sep 15.
Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria.
This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25.
A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis.
Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.
结核病是一项全球公共卫生挑战，在全球范围内对发病率和死亡率有重大影响。本研究旨在调查叙利亚一家医院收治的肺结核（PTB）和肺外结核（EPTB）患儿的流行病学、临床特征、诊断方法及早期死亡率。
本回顾性队列研究在叙利亚大学儿童医院开展，纳入2013年1月至2023年1月期间诊断为结核病的患儿。数据从病历中收集，包括社会人口学特征、诊断方法、临床表现、胸部X线检查结果及患者结局。使用SPSS 25版进行统计分析。
本研究共纳入129例患者，其中26.4%诊断为PTB，73.6%诊断为EPTB。EPTB最常见的类型是淋巴结核（25.6%）和胃肠结核（17.1%）。PTB和EPTB患者在年龄、体重或性别方面无显著差异。明显咳嗽在PTB病例中更常见（67.6%），而淋巴结病在EPTB病例中更普遍（48.4%）。58.1%的患者胸部X线检查有异常，PTB患者更可能有异常表现（97.1%）。PTB病例的微生物学确诊率（76.5%）高于EPTB病例（25.3%）。总死亡率为14%，EPTB患者死亡率更高（16.8%），尤其是结核性脑膜炎病例。
我们的研究突出了住院儿童结核病的流行病学挑战，重点是EPTB诊断和管理的复杂性。我们强调迫切需要加强诊断和管理策略，特别是在叙利亚等冲突地区，结核病控制工作面临重大障碍。鉴于EPTB的高发病率及其相关死亡率，迅速采取解决办法对于改善结局至关重要。临床建议强调在儿童结核病诊断中需要全面的接触史并了解各种临床表现。
