1 - Unidade de Infeciologia pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- The 13th Excellence in Pediatrics Conference, publicação sob apresentação oral.
Background Tuberculosis (TB) is one of the main causes of infection-related deaths in the world. Severe forms of disease such as meningitis and miliary form are rare, but more common in children and have important morbidity. Since 2017 the BCG vaccine is no longer administered to every child who is born in Portugal.
Methods Descriptive study about patients until 18 years-old admitted with tuberculous meningitis or miliary tuberculosis in a tertiary pediatric hospital, from 2008 to 2021 (14 years).
Results We report 18 cases of severe TB: tuberculous meningitis (9), miliary TB (8) and both tuberculous meningitis and miliary TB (1). The median age was 8 years (min 1 month, max 17 years) and four cases in emigrant children. 12/18 (67%) had BCG vaccination. In seven (39%) cases it was possible to identify an epidemiological link in cohabitants. Three patients had chronic disease (neurologic disease, HIV) and all of these had miliary. The tuberculin test was positive only in three children and the Interferon Gamma Release Assay in seven. The Mycobacterium tuberculosis was identified by microbiology/molecular biology in 7/18 in gastric aspirate (5), bronchoalveolar lavage (1), cerebrospinal fluid (1) and ganglionar biopsy (1). Nine children (50%) had complications: hemophagocytic syndrome (1), epilepsy (2) and psychomotor development delay (1), middle cerebral artery stroke with hemiparesis (1), cerebral media vasculopathy (1), hydrocephaly (1), intracranial hypertension (2), VI and VII cranial polyneuropathy (1), psychiatric consequences (1), localized adhesive peritonitis and pneumoperitoneum (1).
Conclusions Severe forms of TB remain an important and potentially preventable cause of childhood illness. Diagnostic difficulties are the greatest challenge - conventional diagnostic tests have sub-optimal sensitivity and specificity, and obtaining specimens is hard. A high index of clinical suspicion and timely institution of anti-tuberculosis treatment can be lifesaving.
Palavras Chave: miliary tuberculosis, tuberculous meningitis