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MSF Paediatric Days
MSF Paediatric Days 2022. 6 June 2023
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Bhutta ZA
MSF Paediatric Days 2022. 30 November 2022
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Petrucci R
MSF Paediatric Days 2022. 1 December 2022
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Conference Material > Abstract
Josaphat A, Saldanha AM, Mwanga JP, Simon A
MSF Paediatric Days 2022. 26 November 2022; DOI:10.57740/ttb5-d359
INTRODUCTION
Tuberculosis (TB) and severe acute malnutrition (SAM) are major health problems in east Democratic Republic Congo (DRC), a setting with persistent armed conflict and population displacement. Diagnosis of TB in children is difficult as symptoms are non-specific and diagnostic sensitivity is low, especially in SAM.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-year old girl was referred for a 2-week history of fever, cough, weight loss, and swelling of the limbs and face. On examination she was febrile and tachycardic, with pedal edema up to the knee, facial puffiness, and bilateral crepitations on auscultation. She lived in an overcrowded camp for internally displaced people. Her older brother had similar symptoms and neighbours had recently started TB treatment. She was admitted with a working diagnosis of SAM-Kwashiorkor type, acute pneumonia, and suspicion of TB. At day 5, her fevers continued despite IV broad-spectrum antibiotics. Chest x-ray was insignificant. Sputum microscopy and GeneXpert on gastric aspirate were both negative for TB. She developed abdominal distension and a spontaneous fistula at the umbilicus (photo), discharging milky fluid that was thought to be digested nutritional milk. Anti-tuberculosis treatment was started based on strong clinical suspicion of extra-pulmonary TB (EPTB). Within 2 weeks she improved clinically and nutritionally, the fistula spontaneously closed eliminating the need for surgery, and she could be discharged.
DISCUSSION
This case highlights the difficulties of diagnosing EPTB in children with SAM. Diagnosis relies heavily on clinical suspicion and epidemiological information. Negative sputum microscopy and GeneXpert gastric aspirate analysis do not rule out TB. Early initiation of treatment is the most important factor affecting mortality, thus empirically starting treatment should be considered. Spontaneous enterocutaneous fistulas caused by TB are rare, and there is limited literature describing their presentation or treatment. In our case, an empiric conservative treatment approach was very successful and even eliminated the need for surgery.
Tuberculosis (TB) and severe acute malnutrition (SAM) are major health problems in east Democratic Republic Congo (DRC), a setting with persistent armed conflict and population displacement. Diagnosis of TB in children is difficult as symptoms are non-specific and diagnostic sensitivity is low, especially in SAM.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-year old girl was referred for a 2-week history of fever, cough, weight loss, and swelling of the limbs and face. On examination she was febrile and tachycardic, with pedal edema up to the knee, facial puffiness, and bilateral crepitations on auscultation. She lived in an overcrowded camp for internally displaced people. Her older brother had similar symptoms and neighbours had recently started TB treatment. She was admitted with a working diagnosis of SAM-Kwashiorkor type, acute pneumonia, and suspicion of TB. At day 5, her fevers continued despite IV broad-spectrum antibiotics. Chest x-ray was insignificant. Sputum microscopy and GeneXpert on gastric aspirate were both negative for TB. She developed abdominal distension and a spontaneous fistula at the umbilicus (photo), discharging milky fluid that was thought to be digested nutritional milk. Anti-tuberculosis treatment was started based on strong clinical suspicion of extra-pulmonary TB (EPTB). Within 2 weeks she improved clinically and nutritionally, the fistula spontaneously closed eliminating the need for surgery, and she could be discharged.
DISCUSSION
This case highlights the difficulties of diagnosing EPTB in children with SAM. Diagnosis relies heavily on clinical suspicion and epidemiological information. Negative sputum microscopy and GeneXpert gastric aspirate analysis do not rule out TB. Early initiation of treatment is the most important factor affecting mortality, thus empirically starting treatment should be considered. Spontaneous enterocutaneous fistulas caused by TB are rare, and there is limited literature describing their presentation or treatment. In our case, an empiric conservative treatment approach was very successful and even eliminated the need for surgery.
Conference Material > Video
Haciomeroglu K
MSF Paediatric Days 2022. 30 November 2022
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Conference Material > Poster
Doherty M, Richardson K, Luraschi D
MSF Paediatric Days 2022. 30 November 2022; DOI:10.57740/b9zg-kp07
Conference Material > Poster
Verástegu C, Yantzi R, de la Osada A, Bin Ayub J, Abdullah Al Imran J, et al.
MSF Paediatric Days 2022. 30 November 2022; DOI:10.57740/2dt3-vf97
Conference Material > Poster
Goodyer J, Elbadawi H, Mayronne S, Lynch E, Michel J, et al.
MSF Paediatric Days 2022. 30 November 2022; DOI:10.57740/2cfg-vx89
Conference Material > Poster
Rau C, Lüdecke D, Dumolard LB, Grevendonk J, Wiernik BM, et al.
MSF Paediatric Days 2022. 30 November 2022; DOI:10.57740/m9jz-9n26
Conference Material > Poster
Martinez Torre S, Carreño C, Sordo L, Llosa AE, Ousley J, et al.
MSF Paediatric Days 2022. 30 November 2022; DOI:10.57740/88gr-bc57