medigraphic.com
ISSN 2683-1678 (Print)
Órgano Oficial de la Sociedad
Latinoamericana de lnfectología Pediátrica.
Órgano de la Asociación Mexicana de
Infectología Pediátrica, A.C.
Órgano difusor de la Sociedad Española
de lnfectología

2022, Number 2

<< Back Next >>

Rev Latin Infect Pediatr 2022; 35 (2)

Risk factors for prediction of immunodeficiencies in children with tuberculosis. Experiencie of a third level hospital in Mexico

Cristerna TGH, Hernández SAA, Castillo BJI, González SN

Language: Spanish
References: 13
Page: 67-73
PDF size: 244.16 Kb.


ABSTRACT

Introduction: Tuberculosis (Tb) is an infectious disease caused by Mycobacterium tuberculosis which is particularly severe in children less than 5 years old and with immunocompromise. There is limited evidence regarding the clinical manifestations, radiographic findings, infection localization and species of microorganisms found in immunocompromised children with Tb. Material and methods: At the Instituto Nacional de Pediatría from 2012 to 2019 medical records of patients with Tb were analyzed. Patients with Bacillus Calmette-Guérin (BCG) vaccine adverse effects and incomplete medical information were excluded. Demographic data, type of immunocompromise, clinical findings, BCG vaccination, radiologic and microbiologic findings were documented. Frequencies between healthy and immunocompromised patients was compared using χ2 and a statistical significance of p ≤ 0.05 was established. Results: Data was obtained of 122 patients with Tb diagnosis of which 34.4% had immunocompromise. Fifty one percent of healthy and 61.9% of immunocompromised patients were male. Mean age (months) at presentation was 94.4 in healthy and 84.4 in immunocompromised patients. Children less than one year of age had 9.5 more probabilities of having immunocompromise, meanwhile, children from 5 to 9 years old had three times less risk of immunocompromise. Immune defects most frequently found were Chronic Granulomatous Disease (GCD) in 26.1%, Severe Combined Immunodeficiency (SCID) 23.8%, and IL-12/IFN-gamma pathways defect in 16.6%. Lymphadenitis was the most frequent localization in both groups; between both groups, disseminated Tb was more frequent in immunocompromised and bone Tb was more frequent in healthy children. Clinical findings were similar in both groups. Immunocompromised patients had more frequently abnormal radiographic findings and less frequently a TST positive test than healthy patients. M. bovis was more frequently found in immunocompromised patients than in healthy patients without statistical significance. Conclusions: Immunocompromised patients presented with Tb disease at younger ages, had more frequent disseminated disease and abnormal radiographic findings. Diagnosing children less than one year old with or without disseminated disease should make clinicians promptly assess for immunodeficiencies.


REFERENCES

  1. Daniel TM. The history of tuberculosis. Respir Med. 2006; 100 (11): 1862-1870.

  2. WHO. Global tuberculosis report. WHO Guidel. 2021.

  3. Concepts C, Perez-Velez CM, Marais BJ, Europe W. Tuberculosis in children. N Engl J Med. 2012; 348-360.

  4. Boisson-Dupuis S, Bustamante J, El-Baghdadi J, Camcioglu Y, Parvaneh N, El Azbaoui S et al. Inherited and acquired immunodeficiencies underlying tuberculosis in childhood. Immunol Rev. 2015; 264 (1): 103-120.

  5. Thomas TA. Tuberculosis in children pediatrics. Thorac Surg Clin. 2019; 29 (1): 109-121.

  6. Dunn JJ, Starke JR, Revell PA. Laboratory Diagnosis of Mycobacterium tuberculosis infection and disease in children. J Clin Microbiol. 2016; 54 (6): 1434-1441.

  7. Hernández-Martínez C, Espinosa-Rosales F, Elva S, Hernández-Martínez AR, Blancas-Galicia L, Hernández-Martínez C et al. Basics of primary immunodeficiencies. 2016; 63 (2): 180-189.

  8. Glanzmann B, Uren C, de Villiers N, van Coller A, Glashoff RH, Urban M et al. Primary immunodeficiency diseases in a tuberculosis endemic region: challenges and opportunities. Genes Immun. 2019; 20 (6): 447-454. Available in: http://dx.doi.org/10.1038/s41435-018-0041-0

  9. Lee WI, Huang JL, Yeh KW, Jaing TH, Lin TY, Huang YC et al. Immune defects in active mycobacterial diseases in patients with primary immunodeficiency diseases (PIDs). J Formos Med Assoc. 2011; 110 (12): 750-758. Available in: http://dx.doi.org/10.1016/j.jfma.2011.11.004

  10. Lancella L, Galli L, Chiappini E, Montagnani C, Gabiano C, Garazzino S et al. Recommendations concerning the therapeutic approach to immunocompromised children with tuberculosis. Clin Ther. 2016; 38 (1): 180-190. Available in: http://dx.doi.org/10.1016/j.clinthera.2015.10.012

  11. Conti F, Lugo-Reyes SO, Blancas Galicia L, He J, Aksu G, Borges de Oliveira E et al. Mycobacterial disease in patients with chronic granulomatous disease: a retrospective analysis of 71 cases. J Allergy Clin Immunol. 2016; 138 (1): 241-248.e3.

  12. Cruz AT. Tuberculosis. In: Cherry J, Feigin R editors. Feigin and cherry pediatric infectious diseases. 8th ed. Philadelphia: Elsevier; 2018, 957-987.

  13. Mandal N, Anand PK, Gautam S, Das S, Hussain T. Diagnosis and treatment of paediatric tuberculosis: an insight review. Crit Rev Microbiol. 2017; 43 (4): 466-480. Available in: http://dx.doi.org/10.1080/1040841X.2016.1262813




2020     |     www.medigraphic.com