Miliary tuberculosis in the XXI century - a case report
Introduction: Tuberculosis is still a serious public health problem. Young age and HIV infection are important risk factors for severe or disseminated disease.
Case report: We report the case of a three-year-old girl who presented a prolonged fever without a source on physical examination. Initial laboratory fi ndings were suggestive of urinary tract infection and empirical antibiotic therapy was started. Urine culture confi rmed that diagnosis, but fever had persisted. On complementary investigation, chest X-ray revealed an< infiltrate with a miliary pattern. Mycobacterium tuberculosis was isolated on gastric aspirate, cerebrospinal fluid and urine. Antituberculous therapy and corticoid were initiated with signifi cant clinical improvement.
Conclusions: Even in this era of advanced medical technology, tuberculosis is still a diagnostic challenge, especially when the presentation is atypical and extra-pulmonary. A high index of suspicion by the physician is required because prompt institution of adequate treatment is decisive for fi nal outcome.
Ávalos GGL, Montes de Oca EP. Classic and new diagnostic approaches to childhood tuberculosis. Journal of Tropical Medicine 2012. doi:10.1155/2012/818219
Direcção-Geral da Saúde. Programa Nacional de Luta Contra a Tuberculose. Ponto da Situação Epidemiológica e de Desempenho – Relatório para o Dia Mundial da Tuberculose, Março 2013.
Marais BJ, Schaaf HS. Childhood tuberculosis: An emerging and previously neglected problem. Infect Dis Clin N Am 2010; 24:727-49.
Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis 2008; 8:498-510.
Marais BJ, Graham SM, Cotton MF, Beyers N. Diagnostic and management challenges for childhood tuberculosis in the era of HIV. J Infect Dis 2007; 196:S76-85.
Moreno-Pérez D, Martín AA, Gómez NA, Baquero-Artigao F, Montaner AE, Durán GPA, et al. Diagnóstico de la tuberculosis en la edad pediátrica. Documento de consenso de la Sociedad Espanola de Infectología Pediátrica y la Sociedad Espanola de Neumología Pediátrica. An Pediatr (Barc) 2010; 73: 143.e1-143.e14.
Stop TB Partnership Childhood TB Subgroup. Chapter 1: Introduction and diagnosis of tuberculosis in children. Int J Tuberc Lung Dis 2006; 10:1091-7.
American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000; 161:1376-95.
Starke JR, Munoz FM. Tuberculosis (Mycobacterium Tuberculosis). In: Kliegman: Nelson Textbook of Pediatrics. Philadelphia: Saunders Elsevier; 2007. Ch. 212. p.1240-54.
Cruz AT, Starke JR. Pediatric tuberculosis. Pediatrics in Review. 2010; 31 (1): 13-25.
Bento J, Silva AS, Rodrigues F, Duarte R. Métodos diagnósticos em tuberculose. Acta Med Port 2011; 24:145-54.
Stop TB Partnership Childhood TB Subgroup. Chapter 2: Anti-tuberculosis treatment in children. Int J Tuberc Lung Dis 2006; 10:1205-11.
Asociación Espanola de Pediatria. Grupo de Trabajo de Tuberculosis de la Sociedad Española de Infectología Pediátrica (SEIP). Documento de consenso sobre el tratamiento de la tuberculosis extrapulmonar y formas complicadas de tuberculosis pulmonar. An Pediatr (Barc) 2008;69:271-8.
Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 2009; 59:167-87.
Centre for Disease Control. Department of Health and Community Services. Guidelines for the Control of Tuberculosis in the Northern Territory; 4th ed. 2008. p. 25.
Copyright (c) 2014 NASCER E CRESCER
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.