Respiratory tuberculosis in children and adolescents: Assessment of radiological severity pattern and age-related changes within two decades.

Introduction: Despite the global decline of tuberculosis (TB), the annual risk of TB infection in children from developing countries remains high. Giving the global and regional epidemiological context in the past 20 years and a recent classification, dividing childhood TB into severe and non-severe disease, our aim was to find possible differences regarding disease severity in the pediatric population, as assessed by chest radiography (CXR) over 2 decades.

Materials and method: A retrospective analysis of CXRs from newly confirmed respiratory TB patients was performed at the Pediatric Pulmonology Department of a tertiary-care university hospital that acts as a referral TB center in Transylvania. CXRs were reviewed for all patients suffering from respiratory TB in 1994-1999 (Group A) and all respective cases from 2008-2013 (Group B).

Results: In the 110 respiratory TB cases identified in group A and 73 respective cases found in group B, the male:female distribution was similar, 56%-44%. In group A a severe pattern was present in 34% of patients, while in group B there were 43% of respective cases. The median age for severe disease in group A was 10 years, and 15 years in group B (p < 0.05). Furthermore, in group B there was less mediastinal lymphadenopathy (55% vs. 68% in group A), more cavities (11% vs. 6% in group A) and a significantly higher number of consolidation, 38% vs. 25% (p = 0.04).

Conclusion: CXR findings in the pediatric population have evolved from a mainly nonsevere TB pattern to an increased prevalence of severe disease, found mostly in the adolescents.