Clinical Manifestations And Prognosis Analysis Of 41 Cases Of Children Intestinal Tuberculosis

Objective: To explore the clinical characteristics of intestinal tuberculosis(ITB)in different age children so as to improve the cognitive level and make early diagnosis and treatment.Methods: A total of 41 children patients admitted to the Children’s Hospital of Chongqing Medical University and diagnosed with intestinal tuberculosis from January 2010 to December 2019 were included.According to the age of onset,they were divided into 4 groups: 0～ < 3years old,3～ < 6 years old,6～ < 12 years old and 12～ < 18 years old.Comparing the clinical manifestations,laboratory examination,imaging examination,endoscopy,pathological feature and treatment regimen among different age groups children.Results:(1)General datas: Among the 41 cases of ITB children,there were 19 males and 22 females.The median visiting ages was 11 years old,duration of symptoms outside the hospital was 2 months.10 patients(24.4%)had a clear contact history of tuberculosis,and 74.4% of the children were complicated with Pulmonary tuberculosis.(2)Clinical manifestations: The most common clinical manifestations were fever,abdominal pain and weight loss,accounting for 70.7%,60.9% and 46.3%,respectively.The signs of abdominal tenderness,muscle tension and rebound pain accounted for 51.1%,46.2% and 12.1%,respectively.There was no statistical difference in clinical manifestations and signs among different age groups children.(3)Laboratory examinations: The erythrocyte sedimentation rate(ESR)increased 87.88%,anemia 85.3%,fecal occult blood positive 72.41%.(4)Examinations links to tuberculosis:30 children completed PPD test,the positive rate was 56.67%,28 children completed T-SPOT,the positive rate was 89.29%,16 children completed Xpert MTB/RIF,the positive rate was 75%,40 children completed acid-fast bacilli smear,the positive rate was 42.5%,and 36 children completed tuberculosis bacilli culture,the positive rate was 16.67%.(5)Imaging examinations: 32 children completed abdominal computed tomography(CT)examination,the main manifestations were partial intestinal wall thickening 84.38%,celiac lymph nodes enlargement 81.25% and ascites31.25%.Chest imaging examinations revealed mediastinal/hilar lymph node enlargement/calcification,pleural effusion and so on.(6)Endoscopic and pathological findings: 9 cases completed colonoscopy examination,ileocecal region and ascending colon was the most common involved site,and different extent mucosal erosion and ulceration were observed under the microscope.(7)Treatment and prognosis: The most common therapeutic regimen of ITB was HRZE.And the overall effective rate of different treatment regimens was 77.42%.There were 4(9.76%)children underwent surgical intervention.Conclusions: For the children with long-term unexplained abdominal pain and weight loss,We should consider intestinal tuberculosis,especially in the children who had a close contact with tuberculosis patients,We also consider that ITB patients who are onset of non-digestive system symptoms.The positive rate of etiological diagnosis is low,We can make diagnosis according to contact history,clinical manifestations,imaging and colonoscopy finding.When differential diagnosis is hard,diagnostic anti-tuberculosis therapy maybe a choice after benefit-risk evaluation.