Dr. Bipul Kumar Das (PGT)

Dr. Kumud Pathak, M.D.

Dr. P. Biswanath,Asso. Professor, Dept. of Paediatrics AMCH

A Clinical Study of Tuberculosis in Children with special reference to

Gastric Aspirate

Introduction

Tuberculosis - one of the most common diseases in the world with different names.

Diagnosis difficult in children.

1.5 Million New Cases every year.

130,000 Deaths Each Year.

Different Diagnostic Modalities –

- Clinical Signs & symptoms

- Mantoux Test

- Chest X-Ray

- BAL & Gastric Aspirate for AFB smear

- Culture Techniques

- Serodiagnosis

- Polymerase Chain Reaction

Gastric Aspirate Study for direct smear for AFB and culture is a valuable test for the diagnosis of Tuberculosis in Children

Aims and Objectives

Clinical study of Tuberculosis in Hospitalized children from age 1 – 12 years.

To see the positivity of Gastric Aspirate for AFB in Tuberculosis.

Inclusion Criteria

Provisionally diagnosed cases of Tuberculosis in Age Group of 1 -12 Years (as per WHO

guidelines).

Cases which were diagnosed with Pulmonary or Disseminated Tuberculosis.

Children below 1 year

Children above 12 Year

Exclusion Criteria

Materials & Methods

Study Centre – Department of Paediatrics, AMCH

Morning sample Gastric Aspirate of Probable cases of Pulmonary & Disseminated Tuberculosis.

Sample collection for 3 consecutive days..

Smear Examination by Ziehl Neelsen staining method.

Statistical Analysis – Student ‘t’ test.

Results&

Observations

Age group in Years

34.62%

17.94%

26.92%

20.52%

58.97% 41.03%

Perc

enta

ges

Nutritional Grade

20.51% 17.94%

16.66%

24.35%

20.51%

Normal Grade I Grade II Grade III Grade IV

6.41% 5.12%

19.23%

44.87%

24.35%

Socioeconomic Status

Perc

enta

ges (

%)

51.28% 37.17%

11.53%

80.77%

19.23%

48.71%

51.28%

Mantoux Reactivity with Nutritional Status

Nutritional Status

Perc

enta

ges

72.00% 28.00%

28.88%71.12%

47.05%

23.07%16.67%

12.50%

Age Group (in years)

Perc

enta

ge (%

)

28.57% 27.27%

Perc

enta

ge (%

)

SEX

Author with Year

Age Group Total No. of Cases

No. of AFB Positive cases

% of Positive cases

Abadco et al

(1992)Mean Age 2.5

Years20 10 50.00

Somu et al (1995)

7 months to 2 years

50 16 32.00

Pomputius et al (1997)

Not Mentioned

8 4 50.00

Lobato et al (1998)

< 2 Years 80 33 41.00

Singh et al (2000)

6 months to 14 Years

58 10 17.20

Gomez et al (2000)

Not Mentioned

46 15 32.60

Guillermo et al (2001)

Mean Age 6.8 Years

135 50 37.00

Zar et al (2006)

1 Month to 5 Years

250 40 16.00

Present Study (2006)

1- 12 Years 45 13 28.89

Conclusion

Tuberculosis more common in < 6 years of age.

Poor socioeconomic status and malnutrition have Definite relation.

Mantoux test is Positive in almost half of the patients.

AFB positive in 28.89% children with Pulmonary Tuberculosis in Gastric Aspirate.

Gastric Aspirate for isolation of Tubercle Bacilli

should be tried in every case as far as possible, as

demonstration of AFB is the Gold Standard for

diagnosis of Tuberculosis.