Pediatric Tuberculosis in Northern Sardinia

Abstract

Background and objectives: Migration flux is an increasing phenomenon in Italy, and it raises several public health issues and concerns in pediatric infectious diseases. This study investigated the clinical characteristics and outcomes of a pediatric population at high-risk for tuberculosis (TB) and the potential role of immigration as a risk factor.

Design: We performed an observational retrospective study of children referred to the only Pediatric Infectious Diseases Unit for Northern Sardinia over a 6-year-period (2009-2014). Main variables assessed included TB skin test (TST), confirmed by quantiFERON Gold in Tube test, thorax X-ray (TX), microbiological culture, direct microscopy for acid-fast bacilli and molecular assays.

Results: Of the 246 children (mean age = 5.8 ± 3.9 years) identified, 222 (90.2%) were native to Sardinia and 24 (9.8%) were immigrants. The majority of children (n=205; 83%) were TB-exposed but not infected based on a negative TST and TX. Among the TST positive group (n= 39; 16%), 19 (49%) had latent TB (TX negative), while 20 (51%) had active TB (TX positive). The percent of TST positive children was significantly higher in the immigrant than the native group (42.5% versus 14%, p<0.001). Clinical presentations included pulmonary involvement with hilar lymphadenopathy (72%), pleurisy (13,5%), lateral-cervical lymphadenopathy (9%), pneumonia with calcifications (4.5%) and disseminated TB (4.5%). One child had multidrug-resistant tuberculosis.

Conclusions: Pediatric TB represents a relevant and potentially worsening public health problem in Northern Sardinia. A strict surveillance system and appropriate treatment can prevent the most severe forms and reduce TB transmission.

Keywords: active tuberculosis; latent tuberculosis; multi-drug resistant tuberculosis; tuberculosis household contacts.

Figure 1

TB high-risk pediatric population observed at the referral Center for pediatric TB in the Northern Sardinia: number of native versus immigrant children stratified per calendar year (2009–2014).

Figure 2

Diagnostic and therapeutic flow-chart of our study population, subdivided into the three categories of latent TB (LTBI), active TB and TB exposed children depending on the TST/IGRA and chest-X Ray (TX) negative [−] or positive [+] results.

Figure 3

Chest radiograph and brain MRI images of a 2-year-old girl with disseminated TB.

Figure 4

Chest radiographs at two different time points of a 9-year-old girl with pleurisy.

Figure 5

Chest TC images of 9-year-old girl with pleurisy at the time of TB diagnosis.