ISSN: 2547-9431
Periodical Publication of University of Health Sciences Bagcilar Training and Research Hospital
Evaluation of extrapulmonary tuberculosis cases presenting with different clinical findings
Abdulrahman Ozel, Meltem Erol, Ozlem Bostan Gayret, Can Polat, Ozgul Yigit, Fatih Mete
Bagcilar Medical Bulletin 2018;3(4):65-72
Introduction: Extrapulmonary tuberculosis cases may display different clinical symptoms and this causes a delay in diagnosis. Nutritional deficiencies, migrations, and wars facilitate the development and the spreading speed of the disease. The aim of this article is to examine extrapulmonary tuberculosis patients with different clinical presentations.

Method: In this study, 15 extrapulmoner tuberculosis cases who were hospitalized and treated in our pediatrics clinic in the last two years, has been evaluated retrospectively.

Results: The average age of our group was 11.7 ± 4.5 and six of the assessed patients were Syrian origin. The shared complaints of five patients diagnosed with peritoneal tuberculosis were abdominal pain and bloating. Abdominal ultrasonography findings of the patients in concordance with diffuse ascites. Two of these patients, Mycobacterium tuberculosis had peritoneal effusion. All of the five patients diagnosed with lymph node tuberculosis had swelling on the neck, and all had pulmonary involvement. However, only one patient's lymph node biopsy was concordant with tuberculosis. One patient bone tuberculosis patient applied to our clinic with hip and back pain symptom. Pott’s abscess was observed in the patient's thorax MRI and hip MRI was concordant with tuberculous arthritis. Our patient with renal tuberculosis was diagnosed during evaluation of sterile pyuria attacks and in her urine ARB (+) was detected and M. tuberculosis grew in urine culture. One patient with central nervous system involvement applied to our clinic with clouding of consciousness and headache. The cerebrospinal fluid (CSF) findings of the patient were concordant with tuberculosis and growth was observed in the CSF culture. One case with miliary tuberculosis had hypercalcemia and pulmonary involvement. The patient's M. tuberculosis DNA PCR test was positive in bronchoalveolar lavage fluid. Another patient with pericardial tuberculosis applied due to respiratory distress and had cardiomegaly and pericardial effusion. Nine of our patients also had a contact history, 12 had purified protein derivative of tuberculin (PPD) (+), and 11 had pulmonary involvement.

Conclusion: Patients were admitted to our outpatient clinic with various clinical symptoms. After careful physical examinations were performed, detailed patient histories were taken and laboratory tests performed for differentials, patients were diagnosed with extrapulmonary tuberculosis. It was desired to emphasize that this disease may appear with different clinical presentations in endemic regions like our country.

Keywords: Child, extrapulmonary tuberculosis, pulmonary tuberculosis

REFERENCES
1. Global Tuberculosis Control surveıllance, Planning, Financing. WHO Report, Geneva, 2008.

2. Montoro E, Rodriguez R. Global burden of tuberculosis. In Tuberculosis 2007; from basic science to patient care, Palomino JC, Leão SC, Ritacco V (editors). 1st ed., 2007:263-281.

3. Sreeramareddy CT, Panduru KV, Vermal SC, Joshi HS, Bates MN: Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospitalbased retrospective study. BMC Infect Dis 2008;8(1):8.

4. Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 2004;38(2):199-205.

5. Cagatay AA, Caliskan Y, Aksoz S, Gulec L, Kucukoglu S, Cagatay Y, et al. Extrapulmonary tuberculosis in immunocompetent adults. Scand J Infect Dis 2004;36(11-12):799-806.

6. Herrera V, Perry S, Parsonnet J, Banaei N. Clinical applications and limitations of interferon gamma release assays for the diagnosis of latent tuberculosis infection. Clin Infect Dis 2011;52(8):1031-1037.

7. Lin JN, Lai CH, Chen YH, Lee SS, Tsai SS, Huang CK, et al. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuberc Lung Dis 2009;13(5):620-625.

8. Cruz AT, Starke JR. Clinical manifestations of tuberculosis in children. Paediatr Respir Rev 2007;8(2):107-117.

9. Shingadia D, Novelli V. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis 2003; 3(10): 624-632.

10. Hugo-Hamman CT, Scher H, De Moor MM. Tuberculous pericarditis in children: a review of 44 cases. Pediatr Infect Dis J 1994;13(19):13-18.

11. Carrol ED, Clark JE, Cant AJ. Non-pulmonary tuberculosis. Paediatr Respir Rev 2001;2(2):113-119.

12. Lighter J, Rigaud M. Diagnosing childhood tuberculosis: traditional and innovative modalities. Curr Probl Pediatr Adolesc Health Care 2009;39(3):61-88.

13. DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, et al. Tuberculoma of the central nervous system. J Clin Neurosci 2013;20(10):1333-1341.

14. Dinler G, Sensoy G, Helek D, Kalayci AG. Tuberculous peritonitis in children: report of nine patients and review of the literature. World J Gastroenterol 2008;14(47):7235-7239.

15. Tanrikulu AC, Aldemir M, Gurkan F, Suner A, Dagli CE, Ece A. Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey. J Gastroenterol Hepatol 2005;20(6):906-909.

16. Gürkan F, Ozateş M, Boşnak M, Dikici B, Boşnak V, Taş MA, et al. Tuberculous peritonitis in 11 children: clinical features and diagnostic approach. Pediatr Int 1999;41(5):510-513.

17. Maltezou HC, Spyridis P, Kafetzis DA. Extra-pulmonary tuberculosis in children. Arch Dis Child 2000;83(4):342-346.

18. Santos FC, Nascimento AL, Lira LA, Lima JF, Montenegro Rde A, Montenegro LM, et al. Bone tuberculosis: a case report on child. Rev Soc Bras Med Trop 2013;46(2):249-251.

19. Menke J, Kühnle I. Tuberculous peritonitis with infracarinal mass and elevated CA-125 in a 13-year-old girl. Infection 2014;42(2):415-418.

20. Al-Otaibi A, Almuneef M, Hameed T. An unusual combination of extrapulmonary manifestations of tuberculosis in a child. J Infect Public Health 2012;5(2):203-206.

21. Teo HE, Peh WC. Skeletal tuberculosis in children. Pediatr Radiol 2004;34(11):853-860.

22. Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev 2014;27(1):3-20.

23. World Health Organization. Guidelines on the management of latent tuberculosis infection. WHO, Geneva, 2015.

24. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1376-1395.

25. WHO. Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2nd ed., Geneva, 2014.

26. Oberhelman RA, Soto-Castellares G, Gilman RH, Caviedes L, Castillo ME, Kolevic L, et al. Diagnostic approaches for paediatric tuberculosis by use of different specimen types, culture methods, and PCR: a prospective case-control study. Lancet Infect Dis 2010;10(9):612-620.

27. Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005;365(9454):130-134.

28. Francis J. Curry National Tuberculosis Center. Pediatric Tuberculosis: A Guide to the Gastric Aspirate Procedure, 2006.

29. A Hesseling, A Westra, H Werschkull, P Donald, N Beyers, G Hussey, et al. Outcome of HIV infected children with culture confirmed tuberculosis. Arch Dis Child 2005;90(11):1171-1174.

30. Marais BJ, Graham SM, Cotton MF, Beyers N. Diagnostic and management challenges for childhood tuberculosis in the era of HIV. J Infect Dis 2007;196(Suppl 1):76-85.
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