Tuberculose extrapulmonaire chez les enfants tunisiens référés dans un hôpital pédiatrique tertiaire : aspects cliniques, diagnostic, prise en charge et évolution

Résumé

Background and aims: Tuberculosis (TB) is a public health problem in our country. Extra pulmonary TB (EPTB) is the most common form of TB in children. No Tunisian clinical studies on EPTB in children were published since 2009. This study was conducted to describe clinical features of EPTB in children and to assess management and outcomes. Patients and methods: All children with EPTB diagnosed from January 2010 to December 2021 in a department of a Tunisian pediatric tertiary referral center, were reviewed. Results: EPTB represented 79% of all cases of tuberculosis diagnosed during the study period. The mean age at diagnosis was 7.8±4.2 years. The involved sites were peripheral lymph nodes (40%) followed by abdominal TB (30%), osteoarticular TB (17%), central nervous system TB (11%) and disseminated TB (2%). BCG vaccine was given to 96% of patients. Immunodeficiency was reported in 23% of cases. Mean diagnosis delay was 3.3 months. The longer diagnostic delay was reported in abdominal TB cases (p=0.028). Granulomatous inflammation with caseous necrosis was found in 41% of cases. Mycobacterial culture was positive in 15% of cases. Mean duration of antituberculosis treatment was 10.8±4.5 months. Response to first-line antituberculosis drugs was good in all patients. Three patients had sequelae: vertebral deformation (n=1) and neurological sequelae (n=2). Conclusion: We reported the highest proportion of EPTB in children. The most common site of EPTB was lymph nodes. Vaccination with BCG and screening of children for latent forms of TB are the main measures to control this disease.