April 24, 2013
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Several factors should be considered when diagnosing TB in adolescents

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Tuberculosis features in adolescents mirror those of adults and younger children, according to study published online this month.

Andrea T. Cruz, MD, MPH, from the Department of Pediatrics Sections of Infectious Diseases and Emergency Medicine at Baylor College of Medicine, and colleagues looked at data on 145 adolescents from the Children’s Tuberculosis Clinic in Houston.

Andrea Cruz, MD 

Andrea T. Cruz

The researchers said about third of the patients were born abroad, and diagnoses were most commonly made after the patients presented with symptoms, in contrast to many younger children who are identified during TB contact investigations, often at a time when they remain asymptomatic. Almost three-quarters of cases were preventable.

“The most common symptoms were fever (63%), cough (60%), and weight loss (30%), but 21% were asymptomatic at diagnosis,” Cruz and colleagues wrote. “The most common radiographic findings were infiltrates (34%), lymphadenopathy (27%), cavitary lesions (26%), pleural effusions (19%), and miliary disease (10%).”

Similar to children, sensitivity of acid-fast sputum smears was relatively low.

Therefore, similar to younger children, the clinical diagnosis of TB in adolescents cannot be purely driven by microbiologic findings, according to investigators, including Infectious Diseases in Children Editorial Board ember Jeffrey R. Starke, MD.

“The clinical presentation of adolescents with TB overlaps substantially with features of TB in both younger children and in adults. Clinicians caring for adolescents need to be cognizant of the spectrum of findings seen in this population to decrease time to diagnosis and implementation of effective therapy,” Cruz told Infectious Diseases in Children.

Andrea T. Cruz, MD, MPH, can be reached at the department of pediatrics sections of infectious diseases emergency medicine, Baylor College of Medicine, 6621 Fannin St, Suite A2210 Houston, TX 77030; email: acruz@bcm.eduacruz@bcm.edu.