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Patient Story

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A 17-month-old Hispanic boy presented to the emergency department with a 2-week history of cough, wheezing, fever, and weight loss. The child was born in the US and lives with his dad and uncle, both employed as migrant farm workers. He was admitted to the hospital with the diagnosis of bacterial pneumonia and asthma exacerbation. His initial chest radiograph (CXR) showed right upper and lower lobe infiltrates (Figure 186-1). He continued to have high grade fever despite intravenous antibiotics. After further history revealed that his mother recently died of tuberculosis (TB), he was immediately placed in respiratory isolation. A tuberculin skin test (TST) was positive with a 17 mm of induration, and a computed tomography (CT) of the chest showed a large lymph node compressing the trachea and the right main bronchus (Figure 186-2). Gastric aspirates for acid fast bacilli (AFB) stain and culture were obtained and he was started on anti-TB medications. The culture was positive for Mycobacterium tuberculosis. His father, sister and uncle all had a positive TST and evidence of active pulmonary TB. They were referred expeditiously for evaluation and treatment.

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FIGURE 186-1

Right, upper, and middle lobe infiltrates (circled) due to primary pulmonary tuberculosis on chest x-ray of a 17-month-old boy. (Used with permission from Nazha Abughali, MD.)

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FIGURE 186-2

Compression of the trachea and right main stem bronchus due to an enlarged and necrotic lymph node on chest CT of the boy in Figure 186-1 with primary pulmonary tuberculosis. (Used with permission from Nazha Abughali, MD.)

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Introduction

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Despite the significant decrease in TB rates in the US and other developed countries, tuberculosis continues to be a major cause of morbidity in developing countries. It is estimated that one third of the world’s population is currently infected with TB, with 90 percent occurring in developing countries. Diagnosis of TB in children can be very challenging due to its non-specific clinical presentation and its paucibacillary nature coupled with the decrease in TB expertise among practitioners in developed countries. Without timely diagnosis and prompt institution of appropriate antituberculous therapy, TB in children can be associated with significant morbidity as well as mortality.

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Synonyms

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Tuberculosis: Phthisis, Consumption, Wasting disease, White plague.

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Scrofula: TB adenitis, usually affecting the cervical lymph nodes.

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Pott’s disease: Tuberculosis of the spine.

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Epidemiology

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  • Worldwide, around 9 million new cases of tuberculosis and approximately 1.5 million deaths are annually reported by the world health organization (WHO), with an estimated 500,000 cases and 64,000 deaths occurring among children <15 years of age.1

  • In spite of the steady decrease in TB rates in the US among adults ...

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