Pediatric Tuberculosis Under Six Years Old: a 15-Year Experience of a Level II Hospital

Background: Tuberculosis (TB) disease under 6 years old is an indicator of recent transmission. Strategies to control TB are influenced by its incidence. Portugal became a low incidence country in 2014. In 2016, BCG vaccination switched from universal immunization to risk groups recommendation.

Objectives: Characterization of TB cases in children under six years old in a Pediatric Department of a level II hospital in Lisbon metropolitan area, which serves a high percentage of immigrants from Portuguese-speaking African countries.

Methods: Retrospective and descriptive study of TB disease in patients under six years old treated in our Department between January 2004 and December 2018 (15 years). Demographic, clinical, laboratory, imagiologic and therapeutic data were analyzed. Statistical analysis was performed with SPSS Statistics 25.

Results: 19 patients were included, nine (47%) were diagnosed between 2016 and 2018. Median age of 22 months (min: 0.3, max: 70), 57.9% female. 12 patients had immigrant families from countries with high TB incidence and another three were born in those countries. Seven out of nine patients not immunized with BCG had recommendation to do so. Although a close contact with TB was known in 12 patients at the time of referral to our center, three of those didn’t start on chemoprophylaxis and two were not screened. At diagnosis: four patients had disseminated TB (three miliary TB and one congenital TB), 10 cases had microbiological confirmation by PCR or culture and one case had multirresistant TB. None had HIV infection. Four patients had sequelae (bronchiectasis in one, atelectasis in two, scoliosis in one).

Conclusion: The increase in TB cases under six years old in the last three years points to some pitfalls in TB surveillance and transmission prevention. Although living in a low incidence country, the migration flux must be taken into consideration regarding the prevention of TB.