The retrospective evaluation of cases observed and treated because of tuberculosis at pediatric chest polyclinics of Dicle University Medical School Hospital

Objective: Even though tuberculosis is an illness as old as the history of humanity and its determinant has been known for more than a century, it is still a serious cause of mortality and morbidity. One third of the world's population is infected with this illness and the number of patients with tuberculosis is increasing. The diagnosis of childhood tuberculosis is more difficult than those of adult patients. The goal of our study is to understand which patients consult for the illness in which age span and with which complaints. Besides, it is also conducted to evaluate our diagnosis methods and treatment success. Methods: The patients with tuberculosis diagnostics, who consulted to Dicle University Pediatric Chest Polyclinic between June 2011 and June 2016, and were aged between 0 and 18 years old, were included in the study regardless of their gender. The determination of whether patients received tuberculosis diagnosis and their treatment was started was decided following the co-investigation of epicrisis, laboratory, pathology, and radiology records. The following parameters were taken into account: Patients' age and gender, their mother and father's educational status, economical status of family, smoking situation at home, the presence of other members of the family who might have received tuberculosis treatment, personal risk factors, accompanying illnesses, previously received treatments, involvement location, consulting symptoms, contact with the adult, PPD, BCG, sedimentation, ARB, culture, and TBC PCR in gastric hunger fluid, phlegm and bronchoalveolar lavage fluid, chest radiography, computed chest tomography, pathology results and the treatments they received. Results: There were a total of 109 patients in our study. Our patients were aged between 1-17 years old with a mean age of 10,58±4,4 years. 55 of the patients (50,5%) were male, and 54 of them (49,5%) were female. 24% of the patients (n=26) lived in village, 26% of them (n=28) lived in town, while 50% of them (n=55) lived in city. 69.7% of the patients (n=76) had low economic status (monthly income under 1300 liras), while economic status for 29.4% of them (n=32) was medium (between 1300 and 3500 liras), and it was high (more than 3500 liras) for 0.9% of the patients (n=1). The educational status of the parents was low. Smoking occurred in 58,3% of the houses while this was not case in 41,7% of the houses. 23,9% of patients (n=26) had domestic contact, and 2,8% of them (n=3) had non-domestic contact. The patients had consulted most with the complaints of cough (63,3%, n=69) and fever (36,7%, n=40). The most common involvement location was pulmonary tuberculosis with a percentage of 78,9 (n=86). PPD was positive in 60,5% of the patients (n=66), while 44% of them (n=48) had BCG scar. The most common graphy finding was hilar mediastinal LAP (29,4%), parenchymal infiltration (15,6%), parenchymal infiltration accompanying to hilar or mediastinal LAP (13,8%); the most common tomography finding was hilar, paratrachial and mediastinal LAP (33,9%, n=37). There were 85 patients for whom ARB was examined with any method, and ARB was detected with at least one method in 11 of these patients (12,9%). Reproduction in culture was found in 17% of the patients (n=14). A positive result was obtained from 33,3% of 36 patients (n=11) on whom PCR was investigated. 12 patients had been diagnosed with biopsy. The most of the patients had 6, 9, and 12 months of treatment, compliance to therapy was 90%, and full recovery was 81,6%. Conclusion: Tuberculosis is still a serious public health problem in overcrowded families with lower educational and socio-economic backgrounds. Domestic and non-domestic contacts are risk factors for children. The rate for diagnosis through production in culture, a golden standard in diagnostics, is low, therefore there is a need for alternative diagnosis methods. Computed tomography and pathology is beneficial in the diagnosis of tuberculosis. Key Words: Tuberculosis, acidfast basil, tuberculin skin test, chest radiography