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Archivos de Pediatría del Uruguay

versión impresa ISSN 0004-0584versión On-line ISSN 1688-1249


HOLCBERG, Mónica et al. Prevalence and clinical-epidemiological characteristics of child tuberculosis diagnosed with an index case: Uruguay 2012-2014. Arch. Pediatr. Urug. [online]. 2016, vol.87, suppl.1, pp.S3-S10. ISSN 0004-0584.

The WHO considers tuberculosis a global emergency in public health. There has been an increase in cases in Uruguay since 2011, the current rate being 25.1 out of 105 inhabitants. Research on adult contact with pulmonary active disease constitutes the most effective method to identify children infected with Mycobacterium tuberculosis. Objective: to describe prevalence in patients under 15 years old with tuberculosis, based on a diagnose of an index case and its clinical-epidemiological characteristics Methodology: we conducted a descriptive study between January 1, 2012 and October 1, 2014, using as a source, the data in the medical records of children under 15 years old with a diagnosis of tuberculosis done at the Comisión Honoraria de Lucha Antituberculosa based on an index case. The following variables were analysed in children: age, sex, nutritional condition, concomitant disease, school years, schooling, tuberculin test, bacteriological study, chest X-rays, follow-up adherence, need for hospitalization and resistance. In the index case the variables were the following: family bond or relationship with child, age, bacteriological study, disease location (pulmonary or extrapulmonary), history of incarceration, addictions or concomitant diseases that result in immunodepression, origin and presence of resistance. The median was calculated as a central trend, the same as absolute frequencies and percentages with their corresponding confidence interval of 95%. Results: 1.672 cases of tuberculosis were identified, 497 with contacts under 15 years old. 49% of them transmitted tuberculosis to children (9.9%). Out of the 872 cases studied: 60 developed the disease (6.9%, confidence interval 95%, 5.5-8.8%). 253 children under 15 years old could not be followed up. Out of the 49 index cases: 40 evidence a single contact with the disease younger than 15 years old, the rest of them evidence two or more contacts. The median of age was 30 years old and 49% were first-degree relatives. Bacteriological confirmation was obtained in 95% of cases. Lethality was 8% and two cases presented multiple resistance. Children with the disease have a median age of 4 years old and 60% of them presented an adequate nutritional condition. Most patients (75% - N:45) showed no comorbidity. PPD was positive in 32 of the 51 patients. 93% had a pathological chest x-ray. Bacteriological confirmation by direct test or culture was possible in 35% of cases. Adherence was adequate in 62% (42% of users in the public sub-sector and 80% in the private one). 70% of patients were admitted in the hospital, 57% of them to be studied and to initiate treatment. Multi-drug resistance was found in 2 cases and lethality was 1.7%. Conclusions: tuberculosis is a serious health problem which evidences a gradual increase in the number of cases at the national level. Prevalence of the disease among contacts younger than 15 years old in this study was 6.9%, although the figure may be biased given the difficulties to reach the contacts, the population with a higher risk of getting the disease. Chest X-ray pathology was the greatest pillar to decide initiation of treatment in this population: isolation of the germ is significantly lower than the index case (35% vs 95%). Adherence to treatment is really bad. Identification, follow-up and study of contacts constitute the most important tools for diagnosis and prevention.


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