Analysis Of Clinical And Epidemiological Characteristics Of Tuberculosis In Hospitalized Children

Objective:Through the analysis of clinical data of 355 cases of tuberculosis children hospitalized in Kunming children’s hospital in 6 years,the clinical characteristics and epidemiological characteristics of various types of tuberculosis in children were summarized,so as to improve the understanding of tuberculosis in children,achieve early diagnosis and treatment,and reduce missed diagnosis and misdiagnosis.Method:Clinical data of hospitalized children with tuberculosis aged 0-18 years in our hospital from January 2014 to December 2019 were retrospectively analyzed,including general information,such as age,gender,ethnicity,regional distribution,medical history,symptoms,signs,laboratory examination,imaging examination,prognosis,and pre-hospital experience.SPSS26.0 statistical software was used to analyze and compare the clinical and epidemiological characteristics of tuberculosis,lung complicated with extrapulmonary tuberculosis and extrapulmonary tuberculosis,and to analyze the risk factors of severe tuberculosis.Results:1.General results:There were 204 males(57.4%)and 151 females(42.6%).The age of onset ranged from 22 days to 5 months of 17 years,and the two peak ages of onset were 0-3 years and 6-12 years.There were 281 cases(79.1%)in rural areas and 74 cases(20.9%)in urban areas.2.History:30.1%had a clear tuberculosis exposure history,and 71.8%had a clear BCG vaccination history.The duration of out-of-hospital disease ranged from 1 day to more than 4 years,with an average of 48.1 days,accounting for 87.3%from 1 week to 2 months.3.Symptoms:fever accounted for 76.9%,cough 48.7%,chest tightness and chest pain 5.4%,hemoptysis or blood in sputum 2.5%,abdominal distention and abdominal pain 10.7%,convulsions 9.9%.4.Laboratory examination:the mean value of white blood cells was 10.8x10^9/L,the percentage of neutrophils greater than 0.5 accounted for 69.6%,the percentage of lymphocytes less than 0.5 accounted for 87.9%,119 cases of anemia(33.5%),199 cases of elevated CRP.The number of CSF white blood cells in children with tubercular meningitis was about 81.3%,which ranged from tens to hundreds of X10 ^6/L.Mononucleosis was the main factor,glucose was 1.95mmol/L on average,and chloride was low.5.Etiological tests:the average positive rate of tuberculosis by PCR was 24.4%,which were 50%of gastric fluid,50%of pus fluid,27.2%of cerebrospinal fluid,25.8%of alveolar lavage fluid,25%of thoracic and abdominal fluid,24.6%of sputum,and 10.6%of blood,respectively.The average positive rate of acid-fast staining was 13.4%in sputum,15.4%in gastric juice and 11.1%in alveolar lavage fluid,respectively.The positive rate of PPD was 19.5%,the positive rate of IGRAS was 81.8%,and the positive rate of T-SPOT was 95.7%.6.Imaging examination:the positive rate of chest radiograph was 78.2%,and the positive rate of chest CT was 94.9%.Chest CT was better than chest radiograph in suggesting tuberculosis,pulmonary cavity,calcification,atelectasis,lymph node enlargement/calcification/necrosis,pleural lesions/pleural effusion.The positive rate of head CT was 76.7%,and the positive rate of head MRI was 85%.MRT was more clear than CT in the cerebellum,basal ganglia,low density of midbrain/intrpons,nodular shadow,etc.7.Disease classification:simple tuberculosis accounted for 47.6%,tuberculosis combined with extrapulmonary tuberculosis accounted for 24.2%,and simple extrapulmonary tuberculosis accounted for 28.2%.Severe tuberculosis accounted for 33.2%,while non-severe tuberculosis accounted for 66.8%.8.Immune-related results:CD3+,CD3+CD8+and CD 19+were higher and lower in lymphocyte subsets in the tuberculosis group than in the tuberculosis group combined with extrapulmonary tuberculosis;CD3+,CD3+CD4+,CD3+CD8+and CD 19+ were higher and lower in the tuberculosis group than in the extrapulmonary tuberculosis group;CD3+CD4+was higher in the tuberculosis group than in the extrapulmonary tuberculosis group.CD3+,CD3+CD4+,CD3+CD8+,CD 16+CD56+were lower and CD 19+ were higher in the severe group than in the non-severe group.There was no significant difference between the pulmonary tuberculosis group and the pulmonary tuberculosis group combined with extrapulmonary tuberculosis group and the pulmonary tuberculosis group in humoral immunity.The IgM was higher in the tuberculosis group with extrapulmonary tuberculosis than in the extrapulmonary tuberculosis group,and the IgG and IgA were lower in the severe group than in the non-severe group.9.Logistic regression analysis showed that age of 0 to 3 years,tuberculosis exposure history,no BCG vaccination history and negative PPD were the main risk factors for children with severe tuberculosis(P<0.05).conclusion1.This study shows that males are more than females in children with tuberculosis,and the incidence of children in rural areas is higher than that in urban areas.The peak age of tuberculosis is 0-3 years old and 6-12 years old.2.In this group of cases,fever was the most common clinical manifestation of tuberculosis in children,and children with recurrent fever should be alert to the possibility of Mycobacterium tuberculosis infection.3.Cellular immunity plays a more important role than humoral immunity in children with tuberculosis.Humoral immunity,cellular immunity and innate immunity are all impaired in children with severe tuberculosis,and cellular immune suppression is more serious.4.The positive rate of primary tuberculosis examination in children is low,and the positive rate of immunological diagnosis(PPD,IGRAS,T-SPOT)and imaging examination(chest radiograph,CT,MRI)is high.Relevant examinations are feasible for children who need clinical exclusion or diagnosis of tuberculosis,and can be monitored dynamically.5.Among children diagnosed with tuberculosis,infants(0-3 years old),a history of tuberculosis exposure,no BCG vaccination,and negative PPD were independent risk factors for severe tuberculosis.