Urogenital tuberculosis in children 0 - 14 years old in the structure of other localizations of tuberculosis

Abstract

Introduction. Extrapulmonary tuberculosis (EPTB) still has many features: there is a different approach to its definition in different countries, there is no screening, diagnosis is extremely difficult and requires financial costs, and bacteriological verification does not exceed 46%, complex restorative and reconstructive operations are used in treatment. the proportion of patients with isolated extrapulmonary localizations among tuberculosis patients is low.Purpose of the study. To study the structure of tuberculosis (TB) in children with the accentuation of EPTB in the current conditions to determine the development areas of preventive and diagnostic measures.Materials and methods. A retrospective two-stage study was carried out in the period from 1989 to 2018 among in-patient children aged 0 - 14 yrs. At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p < 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. Among the EPTB, genitourinary tuberculosis prevailed, which can be verified in contrast to damage to other organs. Raising the level of awareness of paediatricians and phthisiatrician-paediatricians about the frequency of EPTB occurrence makes it possible to form alertness in terms of the possibility of their development and to timely detect the disease at an early stage.