Clinical profile and outcome of extrapulmonary tuberculosis in children in Indonesia

Context: Tuberculosis (TB) is a significant problem among children in Indonesia. While pulmonary TB has been widely reported, information on extrapulmonary TB (EPTB) among children in Indonesia has not been well documented. Aims: The aim of this study is to document demographic and clinical characteristics and outcome of EPTB in children. Settings and Design: A retrospective study was conducted in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Subjects and Methods: Medical records were reviewed for all children aged younger than 18 years diagnosed with EPTB and admitted to this hospital between 2009 and 2015. Results: Fifty-three patients with EPTB were admitted to the hospital during the study period. EPTB was more common in children aged >5 years, with median (interquartile range) age of presentation at 12.5 years (4.1–14.7 years). Major presenting symptoms were fever (72%), cough (55%), and weight loss (38%). Common types of EPTB were meningitis (28%), miliary TB (23%), and osteoarthritis (20%). The diagnosis was confirmed by either acid-fast bacilli smear or GeneXpert MTB/rifampicin (RIF) in 13 patients. Evidence of TB infection was documented in 26 % of children with positive result of tuberculin skin test. Mycobacterium TB was detected by GeneXpert MTB/RIF in 23% of children. The mortality rate was 19% which mostly occured in children with meningitis (60%). Conclusion: EPTB was commonly seen in older children, and tuberculous meningitis was both the most common type and cause of death of EPTB in our setting.