1.Pediatric Infecciology Unit, Área de Pediatria, Hospital Dona Estefânia, CHULC, Lisboa, Portugal
2. Pediatric Orthopedic Unit, Área de Pediatria, Hospital Dona Estefânia, CHULC, Lisboa, Portugal
3. Department of Neuroradiology, Hospital Dona Estefânia, Hospital São José, CHULC, Lisboa, Portugal
- Reunião internacional - 39th Annual Meeting of the European Society of Paediatric Infectious Diseases
Resumo:
Background The WHO estimates 10 million newly diagnosed tuberculosis (TB) cases in 2019, 12% in children under 15 years. Extrapulmonary disease accounts for 16%, 10-35% showing musculoskeletal involvement. Bone TB is rare in developed countries, with limited data, especially in pediatric population. We performed a retrospective observational study in all pediatric patients (0-18 years old) diagnosed with bone TB in a 13-year period (from 2008 to 2020) in a tertiary-care hospital, in Lisbon. We aim to assess epidemiology changes and clinical characteristics.
Case presentation summary We identified 18 patients with a median age of 10 years (6-14.8), 66.7% male. 88.9% were foreign-born, most from portuguese-speaking african countries. Chronic disease was present in 5.6% and none had HIV. The mean time until diagnosis was 14 months. The most common symptoms were pain (77.8%), fever (50%) and established deformity (44.4%), 27.7% reporting abnormal gait. Vertebral TB was present in 72.2%, 46.2% being multifocal. Extra-vertebral bone TB affected 55.6%, which 50% showed concomitant vertebral involvement. Diagnostic positive procedures included TST (50%), IGRA (55.6%), compatible histology (33.3%), polymerase chain reaction in 44.4% and Mycobacterium tuberculosis isolation (38.9%), with 28.6% resistant to isoniazid. All patients completed antituberculous drugs for a median of 12 months (12-13), of which 11.1% showed toxicity, and 61.1% were submitted to surgery (45.5% vertebral stabilization). The mean follow-up time was 32.5 months. Local acute complications occurred in 83.3% and sequelae at 12 months follow-up were 50%, of which 55.5% were foreign-born sent to Portugal to receive medical treatment.
Learning points/Discussion Pediatric bone TB is a rare but significant entity with high morbidity, requiring long-term follow-up. Over the last decade foreign-born TB seems to be increasing, with more acute complications and sequelae.
Palavras Chave: Bone tuberculosis; Extrapulmonary tuberculosis; Pediatric bone tuberculosis; Pediatric tuberculosis.