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Paradoxical Reaction During Tuberculosis Treatment in Immunocompetent Children: Clinical Spectrum and Risk Factors

Olive, Carole MD*; Mouchet, Françoise MD*; Toppet, Véronique MD; Haelterman, Edwige MD, MSc; Levy, Jack MD, PhD*

The Pediatric Infectious Disease Journal: May 2013 - Volume 32 - Issue 5 - p 446–449
doi: 10.1097/INF.0b013e3182846c4e
Original Studies

Background: Paradoxical reaction (PR) during antituberculosis (TB) therapy, defined as clinical or radiologic worsening of preexisting TB lesions or the development of new lesions, has not been widely studied in immunocompetent children.

Methods: All children (<17 years) with the diagnosis of TB who sought care at our center between 1994 and 2007 were included in this retrospective study. Data on demographic characteristics, bacteriologic results, medical imaging, treatment regimens and outcomes were abstracted from medical records. Patients with and without PR were compared.

Results: Of 115 TB cases, 12 (10.3%) developed PR. Children with PR were younger than those with TB without complication: median age at diagnosis was 26 months (range, 5–148) compared with 66 months (range, 6–205) for those without complications (P = 0.013). None of the children in the PR group had received Calmette-Guérin bacillus vaccination, compared with 34 of 103 (33%) children without PR (P = 0.017). Children with a diagnosis of PR were more frequently symptomatic at diagnosis of TB disease when compared with children without PR (P = 0.028). PR occurred at a median interval of 39 days (range, 15–75) after initiation of antituberculosis treatment. The most common PR was worsening of preexisting pulmonary lesions (75%). New lesions in anatomical sites other than those observed at initial presentation developed in 3 children.

Conclusion: Paradoxical deterioration during treatment of TB disease is common in immunocompetent children. Young age and absence of Calmette-Guérin bacillus vaccination appeared to be associated with PR.

From the *Pediatric and †Pediatric Radiologic Departments, CHU Saint-Pierre, Brussels; and ‡Immune Health, Gosselies, Belgium.

Accepted for publication December 21, 2012.

CO and FM contributed equally to this study.

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

Address for correspondence: Françoise Mouchet, MD, Pediatric Department, Centre Hospitalier Universitaire St Pierre, 322 rue haute, 1000 Brussels, Belgium. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.