Clinical Characteristics Analysis Of Immunodeficiency Children Infected With Mycobacterium Tuberculosis

Objective: To analyze the clinical characteristics of Mycobacterium tuberculosis infection in children with primary and secondary immunodeficiency disease.Methods: A retrospective analysis was made on the clinical data of immunodeficient children(including primary immunodeficiency group(PID group,n=52)and secondary immunodeficiency group(SID group,n=36))and non-immunodeficient children(control group,n=108)infected with Mycobacterium tuberculosis in Children's Hospital of Chongqing Medical University from January 2010 to September 2019.Results:1.In PID group,the ages of 33(63.5%)cases were between 0 and 1 year old,and 45(86.5%)were male,which were different from those in control group significantly(P < 0.05).There were no significant differences in sex and age between SID group and control group(P > 0.05).2.In SID group,9(25.0%)cases had nephrotic syndrome,8(22.2%)cases had leukemia,and 6(16.7%)cases had systemic lupus erythematosus.In PID group,31(59.6%)cases had chronic granulomatous diseases and 11(21.2%)cases had severe combined immunodeficiency diseases.3.12(36.1%)cases in SID group and 17(32.7%)cases in PID group were complicated with tuberculosis poisoning symptoms except fever,which were lower than that in control group(P < 0.05).4.Miliary shadows in chest CT were found in 5(25.0%)cases in SID group,which were significantly higher than the control group(P < 0.05),but it had no significant differences between PID group and control group(P > 0.05).5.Axillary lymph node lesions were found in 38(73.1%)cases in PID group,which was obviously higher than that in control group(P < 0.05),however it had no obvious difference between SID group and control group(P > 0.05).6.The positive cases of tuberculin skin test in SID group and PID group were 16(47.1%)and 19(48.7%),which were obviously lower than that in control group(P < 0.05).Interferon-gamma test was positive in 3(6.2%)cases of PID group,which was significantly lower than that in control group(P < 0.05),while it had no significant difference between SID group and control group(P > 0.05).7.The numbers of infected lung lobes greater than or equal to 3 lobes were 13(65.0%)cases of SID group and 33(91.7%)cases of PID group,which were significantly higher than those in control group(P < 0.05).55(62.5%)cases in immunodeficient children(8 in SID group and 47 in PID group)had multiple organs infected,which was significantly higher than that in control group(P < 0.05).8.There were latent tuberculosis infection(36.1%)and active tuberculosis(63.9%)in SID group.BCG disease(90.4%)was dominant in PID group,2 cases(3.8%)were complicated with tuberculosis.Conclusion:1.Primary immunodeficiency children infected with Mycobacterium tuberculosis was younger,mainly male.2.Nephrotic syndrome,leukemia and systemic lupus erythematosus were the most common basic diseases in the secondary immunodeficiency group,while chronic granulomatous disease and severe combined immunodeficiency disease were the main diseases in the primary immunodeficiency group.3.The tuberculosis-related symptoms were not typical in the immunodeficient children complicated with Mycobacterium tuberculosis infection,and it was easy to be misdiagnosed and missed diagnosis.4.Miliary shadows in chest CT were more likely to occur in secondary immunodeficiency children complicated with Mycobacterium tuberculosis infection.Axillary lymphadenopathy was more likely to occur in children with primary immunodeficiency.5.The positive rates of tuberculin skin test and interferon-? release test were lower in immunodeficient children,and the possibility of false negative should be considered in immunodeficient children who were highly suspected to be complicated with Mycobacterium tuberculosis infection.6.Multiple lung lobes and organs infected were more like to occur in immunodeficient children than those with normal immunity when complicated with Mycobacterium tuberculosis infection.7.Children with secondary immunodeficiency should be routinely screened for tuberculosis infection no matter whether they had clinical manifestations or not.Tuberculosis also should be screened for in children with primary immunodeficiency in addition to BCG disease.