Üç Aylık Bebekte Tüberküloz Lenfadenit

Year 2019, Volume: 3 Issue: 2, 148 - 152, 29.08.2019

Bahri Elmas , Onur Bircan , Gizem Ay Öner Özdemir , Mustafa Büyükavcı

https://doi.org/10.34084/bshr.597630

Abstract

Tüberküloz
lenfadenit ülkemiz gibi tüberkülozun sık görüldüğü ülkelerde çocukluk çağında
akciğer dışı tüberkülozun en sık rastlanan formu olarak karşımıza çıkmaktadır.
Çocuklarda sıklığının %35-67 arasında değiştiği ve en sık servikal lenf
nodlarında tutulum olduğu bildirilmektedir. 3 aylık kız hasta ateş, solunum
sıkıntısı ve boyunda şişlik nedeni ile çocuk servisine yatırıldı. Akut
lenfadenit ön tanısıyla ampirik antibiyotik tedavisi başlandı. Ampirik
antibiyotik tedavisine yanıt vermeyen hastaya yapılan TDT endürasyon çapı 18 mm
ölçüldü. Aynı dönemde anne de tüberküloz tanısı aldı. Açlık mide suyunda ARB
pozitif değerlendirildi. Tüberküloz PCR ile mycobacterium tuberclosis saptandı. Anti tüberküloz tedavi
başlanan hasta da tedavi sonrası tam remisyon sağlanmıştır. Servikal
lenfadenopati ayırıcı tanısında özellikle erken süt çocukluğu döneminde
tüberküloz öncelikli olarak düşünülmeyebilir. 
Sık görülen bir form olması nedeni ile lenfadenopatili hastalarda her yaşta
tüberküloz düşünülmelidir.

Keywords

Lenfadenit, Süt çocuğu, Tüberküloz

Tuberculosis Lymphadenitis in a Three Month Old Baby

Abstract

Tuberculosis
lymphadenitis is the most common form of extrapulmonary tuberculosis in
childhood in countries where tuberculosis is common. It has been reported that
the incidence varies between 35-67% in children and the most common involvement
is cervical lymph nodes. A 3-month-old girl was admitted to the pediatric
clinic because of fever, respiratory distress and swelling on the neck.  Empirical antibiotic treatment was initiated
with a preliminary diagnosis of acute lymphadenitis.  The TBT induration diameter of the patient,
who did not respond to empirical antibiotic therapy, was measured 18 mm. At the
same time, the mother was diagnosed with tuberculosis.  ARB positivity was found in morning gastric
aspirate before meal. Mycobacterium
tuberclosis was detected by tuberculosis PCR. Anti-tuberculosis treatment was
initiated and complete remission was achieved after the treatment. Tuberculosis
may not be considered primarily in the differential diagnosis of cervical
lymphadenopathy especially in early infancy. Tuberculosis should be considered
at all ages in patients with lymphadenopathy because of its prevalence.

Keywords

Infant, Lymphadenitis, Tuberculosis

References

• 1. World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization; 2017. (cited 2019 June 27). Available from: URL: https://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf.
• 2. Türkiyede Verem Savaş Raporu 2018. Available from: https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/dosya/raporlar/Tu_rkiye_de_Verem_Savas_2018_Raporu_kapakl_.pdf.
• 3. Vanden Driessche K, Persson A, Marais BJ, et al. Immune vulnerability of infants to tuberculosis. Clin Dev Immunol. 2013; 2013: 781320. doi: 10.1155/2013/781320. .
• 4. Santiago-García B, Blázquez-Gamero D, Baquero-Artigao F, et al; EREMITA Study Group. PediatricExtrapulmonary Tuberculosis: Clinical Spectrum, Risk Factors and Diagnostic Challenges in a Low Prevalence Region. Pediatr Infect Dis J. 2016; 35(11): 1175-1181. .
• 5. Sepulveda EVF, Yunda LFI, Herrera KCM, et al. Extrapulmonary tuberculosis in colombian children: Epidemiological and clinical data in a reference hospital. Int J Mycobacteriol. 2017; 6(2): 132-133.
• 6. Marais BJ, Wright CA, Schaaf HS, et al. Tuberculous lymphadenitis as a cause of persistent cervical lymphadenopathy in children from a tuberculosis endemic area. Pediatr Infect Dis J. 2006; 25(2): 142-146.
• 7. Gündeşlioğlu ÖÖ, Kocabaş E. Extrapulmonary Tuberculosis in Childhood. Turkiye Klinikleri J Pediatr Sci 2016; 12(3): 32–38.
• 8. Kaba Ö, Kara M, Odacılar CA, et al. Evaluation of cases of pediatric extrapulmonary tuberculosis: a single center experience. Turk Pediatri Ars 2019; 54(2): 86–92.
• 9. Geldmacher H, Taube C, Kroeger C, et al. Assessment of lymph node tuberculosis in northern Germany: a clinical review. Chest 2002. 121(4): 1177-1182.
• 10. Devrim I, Aktürk H, Bayram N, et al. Differences between pediatric extra-pulmonary and pulmonary tuberculosis: a warning sign for the future. Mediterr J Hematol Infect Dis. 2014; 6(1): e2014058. doi: 10.4084/MJHID.2014.058.
• 11. Aygün D, Akçakaya N, Çokuğraş H, et al. Clinical manifestations and diagnosis of extrapulmonary tuberculosis in children. J Pediatr Inf 2019; 13(2): e74- e79. doi: 10.5578/ced.201922.
• 12. Bozdemir ŞE, Nazlıoğlu HÖ, Hacımustafaoğlu M, et al. Çocuklarda Tüberküloz Lenfadenit. J Pediatr Inf 2012; 6(1): 6-11. doi:10.5152/ced.2012.02.
• 13. Unterweger M, Götzinger F, Bogyi M, et al. Childhood tuberculosis in Vienna between 2010 and 2016. Wien Klin Wochenschr. 2019. doi: 10.1007/s00508-019-1510-9.
• 14. Vallejo JG, Ong LT, Starke JR. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics. 1994; 94(1): 1-7.
• 15. Nakaoka H, Lawson L. Risk for tuberculosis among children. Emerging Infectious Diseases. 2006; 12(9): 1383–1388. doi: 10.3201/eid1209.051606.
• 16. Ellison E, Lapuerta P, Martin SE. Fine needle aspiration diagnosis of mycobacterial lymphadenitis. Sensitivity and predictive value in the United States. Acta Cytol 1999; 43(2): 153-157.
• 17. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. 2016; 63. ;63:e147-e195.