Publication:

Screening of tuberculosis in hospitalized severely acute malnourished children in a tertiary care hospital

Background Tuberculosis (TB) remains one of the leading causes of infectious disease-related morbidity and mortality worldwide. There is an increase susceptibility to TB due to impaired immunity in malnourished children.

Methods This is a cross-sectional study done at a tertiary care hospital over a period of 1 year. Children aged 6 months to 5 years diagnosed with severe acute malnutrition (SAM) based on World Health Organization (WHO) criteria were enrolled in the study. Screening for tuberculosis was performed using:  Monteux test, chest X-ray, sputum or gastric aspirate microscopy or cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis detection.

Results A total of 165 SAM patients were screened for TB.  Prevalence of TB in SAM patient was 3.63%. Among the 6 cases, 4 were extra pulmonary and 2 were pulmonary TB. The most frequent symptoms were cough (34.56%), vomiting (26.66%), and diarrhoea (25.45%). Fever was seen in 24.24%, and weight loss in 14.54%. The Monteux test results was negative in all patients. CBNAAT testing was positive in only 2 patient (1.21%). Out of 165 children, 2.42% had elevated erythrocyte sedimentation rate (ESR) and 14.55% had an abnormal chest X-ray. Mesenteric lymphadenitis was observed in 9 patients (5.45%) in abdominal ultrasonography.

Conclusions This study highlights that clinical features of tuberculosis were nonspecific. Diagnostic limitations were evident as the Monteux test yielded 0% positivity, and CBNAAT only in 1.21%. This study emphasizes the need for high clinical suspicion in paediatric TB, particularly in malnourished children.