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. 2017 Apr 15;9(1):e2017027.
doi: 10.4084/MJHID.2017.027. eCollection 2017.

Pediatric Tuberculosis in Northern Sardinia

Maria Grazia Clemente  1 , Elena Dore  1 , Lidia Abis  1 , Paola Molicotti  2 , Stefania Zanetti  2 , Paolina Olmeo  1 , Roberto Antonucci  1
Affiliations

Pediatric Tuberculosis in Northern Sardinia

Maria Grazia Clemente et al. Mediterr J Hematol Infect Dis. .

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.

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Conflict of interest statement

Competing interests: The authors have declared that no competing interests exist.

Figures

Figure 1
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
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
Figure 3
Chest radiograph and brain MRI images of a 2-year-old girl with disseminated TB.
Figure 4
Figure 4
Chest radiographs at two different time points of a 9-year-old girl with pleurisy.
Figure 5
Figure 5
Chest TC images of 9-year-old girl with pleurisy at the time of TB diagnosis.
See this image and copyright information in PMC

References

    1. Italian Ministry of Health. Guidelines for the control of tuberculosis on the proposal of the Minister of Health under Article 115, paragraph 1, letter b of Legislative Decree 31, March 1998, no. 112.

    1. Bua A, Cubeddu M, Piras D, Delogu R, Zanetti S, Molicotti P. Tuberculosis screening among asylum seekers in Sardinia. J Public Health (Oxf) 2016 Jan;:24. pii: fdv215. [Epub ahead of print] - PubMed
    1. Abubakar I, Griffiths C, Ormerod P. Diagnosis of active and latent tuberculosis: summary of NICE guidance. BMJ. 2012;345:e6828. - PubMed
    1. WHO. Global tuberculosis report 2016. World Health Organization; Geneva: 2016. http://www.who.int/tb/publications/global_report/en/
    1. Tebruegge M, Salo E, Ritz N, Kampmann B On Behalf Of The Paediatric Tuberculosis Network European Trialsgroup Ptbnet. Inclusion of latent tuberculosis infection as a separate entity into the international classification of diseases. Thorax. 2013;68:588. doi: 10.1136/thoraxjnl-2012-202824. https://doi.org/10.1136/thoraxjnl-2012-202824. - DOI - DOI - PubMed