Childhood Tuberculosis Data Between 1994-2005 From 16 Different Centers

1. Childhood Tuberculosis Data Between 1994-2005 From 16 Different Centers

2. Sevgi Pekcan, Nural Kiper, Ayşe Bolat, Elif Dağlı, Ülker Doğru, Fuat Gürkan, Cahit Karakellioğlu, Emine Kocabaş, A. Kadir Koçak, Metehan Özen, Mustafa Öztürk, Türkan Patıroğlu, İsmail Reisli, Özlem Sarısoy, Ayşen Uğuz, Ayten Uyan, Gülnar Uysal, Nevin Uzuner, Ayşe Tana Aslan, Mehmet Köse, Nazan Çobanoğlu, Ebru Yalçın, Deniz Doğru, Uğur Özçelik

3. Worldwide tuberculosis is an important public health problem with an high mortality and morbidity

4. WHO year 2004 data reports tuberculosis incidence as 28/100 000 and prevalence as 45/100 000/year in Turkey.

5. According to Turkısh Ministry of Health (Verem Savaş Daire Başkanlığı) data number of tuberculosis cases were 20.535 by the year 2005. 18.753 of them were new cases.

6. Childhood tuberculosis cases make up of %9 all cases in Turkey. Again according to year 2005 Disease Burden data by the Ministry of Health, tuberculosis is the eighth most common cause of death under 15 years of age.

7. Aims

8. This study was conducted in order to document data of children with tuberculosis followed up at University hospitals and Research hospitals in Turkey between 1994-2005, to rewiev evaluation of a child with tuberculosis in Turkey, and shear these knowledge with other colleagues.

9. We sent questionaires to 30 centers by mail. We evaluated data from 16 hospitals who turn back to our mail.

10. Akdeniz Üniversitesi Tıp Fakültesi (11 hasta) Ankara Üniversitesi Tıp Fakültesi (16 hasta) Atatürk Üniversitesi Tıp Fakültesi (11 hasta) Bolu İzzet Baysal Üniversitesi Tıp Fakültesi (10 hasta) Çukurova Üniversitesi Tıp Fakültesi (16 hasta) Dicle Üniversitesi Tıp Fakültesi (85 hasta) Dokuz Eylül Üniversitesi Tıp Fakültesi (14 hasta) Erciyes Üniversitesi Tıp Fakültesi (54 hasta) Eskişehir Osman Gazi Üniversitesi Tıp Fakültesi (15 hasta) Gaziantep Üniversitesi Tıp Fakültesi Şahinbey hastanesi (12 hasta) Hacettepe Üniversitesi Tıp Fakültesi (88 hasta) Kocaeli Üniversitesi Tıp Fakültesi (15 hasta) Malatya Üniversitesi Turgut Özal Tıp Fakültesi (31 hasta) Marmara Üniversitesi Tıp Fakültesi (25 hasta) Selçuk Üniversitesi Meram Tıp Fakültesi (12 hasta) Ankara Dışkapı Eğitim ve Araştırma Hastanesi (124 hasta) Name of the Centers

11. Patient Distribution of the Centers

12. Children with tuberculosis who were followed up and treated between 1994 and 2005 at 16 centers in Turkey constituted the study population. Diagnosis was considered when there was contact history, tuberculin skin test positivity, detection of acid fast basilli, isolation of M. tuberculosis by culter, Polymerase chain reaction (PCR) positivity, competible radiologic and histopatologic findings.

13. Data includes; contact history with a person with infectious tuberculosis, tuberculin skin test results (PPD RT 23, 2TU intradermally), materials collected for diagnoses (sputum, gastric aspirates, serebrospinal fluid, pleural fluid), culter and susceptibility results, drugs used in treatment and their side effects, duration of treatment, follow up period, recurrences and deaths.

14. Total number of patients whose data were sent to us by 15 university hospital and 1 research hospital were 566. Twentyseven of them were not true tuberculosis disease but actually were tuberculosis infection and we excluded them from the study. Data of remaining 539 patients were evaluated.

15. Data about the immunization status were not clear in all patients. Of the 539 patients 26 were reported as unvaccinated with BCG. Data were not available for the others.

16. In the study group 274 patients were males and 265 were females.

17. Distribution of the patients according to the years between 1994-2005

18. Most of the patients were diagnosed in the last 4 years. This was probably because data belonging to last years were more readyly available.

20. Patients were 10 days-17 years of age.

21. Contact History

22. İndeks vaka • Unknown 325 (%60,2) • Detected 214 (%39,8) Mother-father-brother: 121 kişi (%47,82) Relatives:(uncle, aunt,cousin, sister in law, grand father and grand mother):122 kişi (%48,22) Neighbours: 7 Friend: 3 More than one person: 37 kişi (% 17,28)

23. Only 10 of the index cases have culture positivity and two of them were infected with drug-resistant strains. One of them was resistant to ızoniazid and the other was resistant to both izoniazid and streptomycin.

24. Tuberculin Skin Test Results

25. In our country among those immunized with BCG vaccine, 15mm induration is the cut of value

26. Results of PPD

27. Microbiologic data • Non of the patients were HIV positive.

28. Diagnostic Metods for Tuberculosis

29. ARB was positive in 133 patients. In 27 of them ARB was positive in 2 or 3 samples.

30. In 43 patients (8%) diagnosis was considered with out ARB, PCR and culture results, because contact history and, competible clinical and radiological findings were present.

31. ARB, PCR, Culture Positivity of The Centers

32. ARB positivity was the most common positive finding.

33. Systemic Involvement Organ involvement in 539 patients. • Lung 285 • Lung + other organs 19 1. Lung + bone 5 2. Lung + abdomen 4 3. Lung + eye 1 4 Lung + lymph node 7 5. Lung + pericardium 1 6. Lung + periton 1 • Milier 57 • Skin 3 • Joint 8 • Bone 15 • Lymhnode 33 • Meninks 85 • Perikard 5 • Periton 12 • Renal 9 • Abdominal 6 • Parotis 2

34. Seventy eight culture were positive. In 12 patient’s culture resistant were detected ( %15,38).

35. Properties of Drug-Resistant Patient

36. Treatment and Follow-up Results

37. İmprovement 317 patient • Kontrole gelmeyen 151 patient • Treatment is going on 62 patient • Family give up treatment 5 patient • Treatment fail 2 patient • Sequel 2 patient • Treatment was stoped 1 patient because of side effect • Recurrence 16 patient • Death 8 patient

39. 539 hastadaki tedavi süreleri • Less than6 month 32 patient • 6month 64 patient • 6month intermittent 31 patient • 6-8 month 36 patient • 9month 31 patient • 9month intermittent 28 patient • 10-12 month 104 patient • 12month intermittent 2 patient • 13-18month 23 patient • 24month and more 4 patient • Not followed-up 130 patient • Treatment going on 54 patient

40. Properties of Patients that have TBC Treatment

41. 104 patients’ treatment protocol was including corticosteroid. 71 of these patients were meningial tbc, 16 were miliary tbc, 12 were lung tbc, 2 were peritoneal tbc, 1 was pericardial tbc, 1 was renal tbc.

42. Patients Follow-up Status

43. Properties of Patients that Recurrence was seen

44. Properties of the Ex patients

45. Side-Effects of Treatment

46. Among the treated patients • No side-effects 428 ( %79,4) • Unknown 111 ( %20,5) • Side-Efects 42 ( %7,79)

47. Side-effects; • Hepatitis 30 ( %71,42) • Rash 6 (% 14,28) • Vomiting 1 ( % 2,38) • Nausea 1 ( % 2,38) • Flu like syndrome 1 (% 2,38) • Optic neuritis 1 (% 2,38) • Hepatic ensephalopathy 1 (% 2,38) • Opti neuritis, hearing loss 1 (% 2,38)

48. As a conclusion; serious forms of tbc as miliary tbc and tbc meningitis are going on more than one place in our country and they do not have common treatment and follow-up period.

49. We think that diagnosis and treatment of childhood tuberculosis needs as we separate for adult tuberculosis as from the common limited sources of developing countries.