Clinical Manifestations and Diagnosis of Extrapulmonary Tuberculosis in Children

Objective:Tuberculosis (TB) is an important public health problem both in developing and developed countries due to migration with increasing incidence despite control strategies. Various clinical manifestations of extrapulmonary tuberculosis (EPTB) cause delay in diagnosis and treatment. In the present study, we aimed to evaluate the clinical and laboratory findings of extrapulmonary tuberculosis in childhood

Is it safe to use anti-TNF-alpha agents for tuberculosis in children suffering with chronic rheumatic disease?

To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients diagnosed with juvenile idiopathic arthritis (JIA) and other chronic rheumatologic diseases treated with anti-TNF-alpha treatment (etanercept, infliximab, adalimumab) in Turkey, 144 patients were evaluated retrospectively for the development of tuberculosis. Patients were evaluated every 6 months for tuberculosis using history, physical examination, tuberculin skin test (TST), chest radiographs, and, when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A tuberculin skin test over 10 mm induration was interpreted as positive. Patients were diagnosed with JIA (n = 132), enthesitis-related arthritis (ERA; n = 14), juvenile psoriatic arthritis (JPsA; n = 4), chronic idiopathic uveitis (n = 4), and chronic arthritis related to FMF (n = 8). Mean age was 12.25 +/- A 3.96 years (4.08-19.41 years), mean duration of illness was 5.86 +/- A 3.77 years (0.66-15 years), and the mean duration of anti-TNF-alpha treatment was 2.41 +/- A 1.47 years (0.6-7 years). Anti-TNF-alpha agents prescribed were etanercept (n = 133), infliximab (n = 30), and adalimumab (n = 6). When unresponsive to one anti-TNF-alpha therapy, patients were switched to another. There was no history of contact with individuals having tuberculosis. During follow-up, seven patients (4.8%) with positive TST were given INH prophylaxis. One oligoarticular JIA patient (0.69%) diagnosed with secondary uveitis who had been followed for 5 years and had been using infliximab for 2 years, developed a positive Quantiferon-TB test while on INH prophylaxis. He was started on an anti-tuberculosis drug regimen. In conclusion, anti-TNF-alpha treatment in children with chronic inflammatory disease is safe. Follow-up every 6 months of children on anti-TNF-alpha treatment with respect to tuberculosis by the pediatric infectious disease department is important to prevent possible complications

Primary Intracranial Abscess localized in the Basal Ganglia: A Case Report

Brain abscesses are serious infections that cause neurological problems and generally require antibiotic treatment and surgical drainage. Hematogenous brain abscesses are generally located in the region fed by the middle cerebral artery, but are occasionally found in deep tissues, such as the basal ganglia and thalamus

Comparison of oral microflora in selective IgA deficiency and X linked agammaglobulinemia cases with control group

Aim: X linked agammaglobulinemia (XLA) and selective IgA deficiency are predominantly antibody deficiency syndromes. Recurrent sinopulmonary infections are common problems observed in both diseases. IgG, IgM and salivary IgA which are present especially in gingival crevice are involved in the defense of the oral cavity. The aim of our study was to investigate oral mucosa, dental health and microfloral variation in selective IgA deficiency and XLA patients by comparison with the healthy group

Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy

Turkmen Z, Ziyalar N, Tari I, Mercan S, Kayiran SM, Sener D, Cengiz S, Akcakaya N. Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy. Turk J Pediatr 2012; 54: 283-286