Clinical perspectives of childhood tuberculosis in Taiwan

Numbers of confirmed childhood and adult tuberculosis (TB) cases per year in Taiwan, 2003–2010. Adapted from Notifiable Infectious Disease Statistics System (NIDSS), Centers for Diseases Control, Taiwan.

Is latent tuberculosis infection (LTBI) true LTBI? A 3-year-old girl with TB exposure history showed coarsening of bilateral peribronchovascular bundles and increased lung markings in the right lower lung. Two of three consecutive gastric aspirate cultures were positive for Mycobacterium tuberculosis.

Primary tuberculosis (TB) infections with adenitis. A 22-month-old girl had not received Bacillus Calmette-Guérin (BCG) vaccination. Her grandmother was diagnosed with pulmonary TB. She had no fever, cough, or changes in bodyweight. (A) Tuberculin skin test showed induration larger than 40mm with bulla formation. (B) The chest computerized tomography (CT) showed bulky calcifying lymph nodes (arrow) at right paratrachea, pretrachea, subcarina, and bilateral hilum.

Primary tuberculosis (TB) infections: pleuritis with pleural effusion. (A) A 12-year-old boy was referred to our hospital because of massive pleural effusion without response to conventional antibiotics therapy. (B) There was no significant lung parenchyma involvement in the follow-up radiograph (after 6-month anti-TB treatment). Pleural effusion culture yielded Mycobacterium tuberculosis despite negative smear results. His grand-aunt was also diagnosed with pulmonary TB.

Secondary (post-primary) pulmonary tuberculosis. A 16-year-old male had a chronic cough and lost 10kg bodyweight during the previous 6 months. (A) On admission, the chest X ray showed patchy, poorly defined consolidation with multiple cavitations over right upper lobe and upper segment of right lower lobe (posterior–anterior view). (B) Computed tomography (CT) showed bronchiectasis with bronchial wall thickening and a so-called ‘‘signet ring sign’’ (arrow).

Secondary pulmonary tuberculosis (TB) with pleural effusion. A 17-year-old male visited the emergency department having had a 3-day fever. He had a chronic cough for 3 months. His grandfather was diagnosed with pulmonary TB 6 months earlier. (A) On admission, chest radiograph showed right upper lung patches with parapneumonic opacities (arrows). Computed tomography (CT) showed right apical lung cavitations, (C) right upper lung bronchiectasis with multifocal consolidation and “tree-in-bud” opacities, and (D) local pleural thickening and effusion. Pleural fluid was positive for Mycobacterium tuberculosis in TB-PCR analysis. (B) Follow-up radiographs 6 months after complete anti-TB treatment showed complete resolution.

Tuberculosis (TB) involving the central nervous system (CNS). A 14-year-old girl was diagnosed with pulmonary TB 2 months before admission. She visited our emergency department because of neck stiffness and fever for 3 days. (A) Chest radiographs at admission showed patchy, poorly defined consolidation for the upper lobes, which are characteristic of secondary pulmonary TB. Sputum smears were heavily positive for acid-fast bacilli and culture positive for Mycobacterium tuberculosis thereafter. Magnetic resonance imaging (MRI) 2 months later showed cerebritis at left basal ganglia, left thalamus, left cerebellar peduncle, left midbrain, and left pons. (B) T2-weighted MRI showed the presence of granuloma, a so-called “paradoxical response”.