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Adolescents With Tuberculosis: A Review of 145 Cases

Cruz, Andrea T. MD, MPH; Hwang, Kevin M. BA; Birnbaum, Gilad D. BA; Starke, Jeffrey R. MD

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182933214
Original Studies
Abstract

Background: Adolescents comprise one-third of pediatric tuberculosis (TB) cases in the United States, but there are few specific data on the epidemiology and clinical course in this population.

Methods: This was a retrospective review of adolescents (12–18 years old) seen at a Children’s Tuberculosis Clinic in Houston, TX, from 1987 to 2012.

Results: One hundred forty-five adolescents were identified; median age was 15.4 years: 50% female, 55% were Hispanic, 26% black, 13% Asian and 1% white; 54 were born abroad. Diagnoses were made after symptomatic presentation in 79%, during contact investigations in 14% and after screening tuberculin skin testing in the remainder. The most common symptoms were fever (63%), cough (60%) and weight loss (30%), but 21% were asymptomatic at diagnosis. Only 8% of adolescents with intrathoracic TB had hemoptysis. One hundred fourteen (78.6%) had isolated intrathoracic TB, 4 (2.8%) had intra- and extrathoracic TB and 27 (18.6%) had extrathoracic TB. The most common sites of extrathoracic TB were peripheral lymphadenopathy (10) and meningitis (6). The most common radiographic findings were infiltrates (34%), lymphadenopathy (27%), cavitary lesions (26%), pleural effusions (19%) and miliary disease (10%). Acid-fast bacillus smears and mycobacterial cultures were attempted for 97 of 118 adolescents with intrathoracic and 22 of 27 with extrathoracic disease, respectively, resulting in smear/culture positivity in 25% and 54% and 18% and 45%, respectively. Two patients died, 2 had relapse, 7 had significant sequelae and 92% recovered without complication. Seventy three percent of cases potentially were preventable.

Conclusions: The clinical, radiologic and microbiologic findings in adolescents with TB have features seen in both younger children and adults; most cases were preventable.

Author Information

From the Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Accepted for publication March 20, 2013.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Andrea T. Cruz, MD, MPH, Department of Pediatrics, Sections of Infectious Diseases & Emergency Medicine, 6621 Fannin Street, Suite A2210, Houston, TX 77030. E-mail: acruz@bcm.edu.

© 2013 by Lippincott Williams & Wilkins, Inc.