Chest radiographic findings and clinical determinants for severe pulmonary tuberculosis among children and adolescents in Malaysia

摘要

Aim ― This study aimed to describe the characteristic of chest radiographic findings at diagnosis in children with pulmonary tuberculosis and to determine the clinical determinants for severe pulmonary tuberculosis among children and adolescents in Kelantan, a northern state of Peninsular Malaysia from 2012 until 2015. Material and Methods ― This was a comparative cross-sectional study between mild and severe pulmonary tuberculosis patients according to chest radiographic findings among children and adolescents using Tuberculosis Information System as a source population. All notified cases that fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Results ― Out of 388 pulmonary tuberculosis radiographs, majority had minimal lesion (69.8%), followed by moderately advanced lesion (23.5%), no lesion (4.9%) and lastly, far advanced lesion (1.8%). Clinically among the severe form of pulmonary tuberculosis, none was human immunodeficiency virus (HIV) positive, 23.5% smokers, 19.4% had no Bacillus Calmette-Guerin (BCG) scar and 72.4% had positive pre-treatment Acid-Fast Bacilli (AFB) sputum smear. In multiple logistic regression, cigarette smoking (adjusted odds ratio (AOR) 1.43, 95% confidence interval (CI): 1.21-3.61, p=0.03), positive sputum AFB smear (AOR 2.32, 95% CI: 1.29-4.13, p=0.004) and absent BCG scar (AOR 1.24, 95% CI: 1.12-8.04, p=0.002) were significantly associated with severe pulmonary tuberculosis. Conclusion ― In conlusion, majority of pulmonary tuberculosis in children and adolescents were of mild severity in Kelantan. Cigarette smoking, pre-treatment positive sputum AFB smear and absent BCG scar were important clinical determinants for severe pulmonary tuberculosis. Hence, the study provides information that would assist in prevention of severe pulmonary tuberculosis in children and adolescents.