CLINICAL PROFILE OF
TUBERCULOSIS IN INFANTS LESS THAN SIX MONTHS OF AGE
Ray M1 , Singhi PD1, Parmar V2
1Advanced Pediatric Centre, P.G.I.M.E.R.,
Chandigarh, India
2Government Medical College, Chandigarh, India
Objective: Missed diagnosis of tuberculosis (TB) in
very young infants has serious consequences. The aim of this study is to
highlight the clinical profile of TB in infants less than 6 months so as to
sensitize pediatricians to this possibility and aid in early diagnosis of
this of ten fatal conditions.
Methods: Retrospective study. Records of 21 infants less
than 6 months admitted between Jan1998-Dec2000 diagnosed to have TB were
analyzed.
Results: The mean age was106 days (range18 ¨C180 days); 5
infants were less than 3 months. Males were predominantly affected.
(76.2%). 11 infants belonged to rural areas and 5 were slumdwellers.14
infants received BCG vaccine. Fever (76.2%, cough (52.4%), vomiting
(42.9%), failure to thrive (52.4%), altered sensorium (47.6%), seizures
(38.1%) and neurodeficits (38.1%) were the common presenting complaints.3
infants presenting in the neonatal period were premature. Clinical signs
were pallor (13), abnormal respiratory findings. (13), hepatosplenomegaly
(8) and neurological abnormalities (10). Obstructive jaundice (2) and
bleeding manifestations; (2) were also noted. Contact with TB could be
identified in 13 of which 11 were mothers suffering from pulmonary (9), CNS
(1) and lymph nodal (1) TB. 7 of the mothers who were contacts had
previously unsuspected TB. Mantoux test was positive in 19%. Abnormal chest
radiography, neuroimaging and cerebrospinal fluid results were found in
62%, 47.6 % and 38% respectively. 1 case was HIV positive. Disseminated,
CNS and pulmonary TB were diagnosed in 12, 4 and 5 infants respectively. On
treatment 5 (23.8%) died while others recovered.
Conclusions: High index of suspicion is necessary for
early diagnosis of TB in very young infants as they have nonspecific
symptoms and signs at presentation. Valuable information was obtained by contact
investigation of the household and mother was the primary source in most
cases.