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Vojnosanitetski pregled
2018, vol. 75, iss. 5, pp. 516-520
article language: English
document type: Case Report
published on: 09/08/2018
doi: 10.2298/VSP160322282K
Creative Commons License 4.0
Difficulties in diagnosis of tuberculosis without bacteriological confirmation in a 15-year-old boy after the contact with a patient with tuberculosis: A case report
aClinical Centre Kragujevac, Pediatric Clinic + University of Kragujevac, Faculty of Medicine
bUniversity of Kragujevac, Faculty of Medicine + Clinical Center Kragujevac, Clinic of Pulmonology

e-mail: goca


After the contact with a patient suffering from tuberculosis (TB), previously healthy children have 1%-16% possibility to develop the disease. TB diagnosis in children is not easy to confirm so 15%-25% of cases remain undiagnosed. Case report. A 15-yearold-boy was hospitalized with productive cough, pain in the right flank area, fever, and fatigue, loss of appetite and night sweats. One of the boy's uncles was cured of tuberculosis, another uncle had active tuberculosis and both of them were in contact with the boy, but they did not live in the same household. During the physical examination, the child was febrile, with dyspnea, pale, with profuse sweating, debilitate. BCG (Bacillus Calmette - Guérin) scar was present. The auscultatory findings of the lungs showed quiet breathing from the scapula to the right lung base and chest radiography suggested massive right sided pleuropneumonia. The parameters of the inflammation were high and Mycobacterium tuberculosis (MTB) was not found in the samples of sputum and gastric lavage. Pleural puncture revealed exudative nature in the aspirated fragment. Cytology was nonspecific, the MTB was not found and the planted surfaces on Lowenstein-Jensen remained sterile. Tuberculin skin test (TST) - Mantoux was positive (+ 10 mm), Interferon Gamma Release Assay (QuantiFERON-TB GOLD In-Tube) was negative. The boy was unsuccessfully treated with broad spectrum antibiotics. By video-assisted thoracoscopy, the pleural tissue clip confirmed the benign chronic granulomatous process, while histochemical staining did not show MTB. The treatment with anti-TB medication led to clinical and radiographic recovery. The boy is now in good general condition, without consequences of the disease. Conclusion. This case report pointed out the importance of risk factors and difficulties in diagnosing TB in children.



Amdekar, Y. K. (2010) Consensus statement on childhood tuberculosis. Indian Pediatrics, 47(1): 41-55
Berti, E., Galli, L., Venturini, E., de Martini, M., Chiappini, E. (2014) Tuberculosis in childhood: a systematic review of national and international guidelines. BMC Infectious Diseases, 14(Suppl 1): S3
Cozma, G., Tudorache, V., Burlacu, O., Tunea, C., Voiculescu, V., Vancea, D., i dr. (2007) Our experience in the thoracoscopic surgery of the tuberculous pleural effusions. Pneumologia, 56(2): 73-6, (Romanian)
de Pascale, G., Bello, G., Tumbarello, M., Antonelli, M. (2012) Severe pneumonia in intensive care. Current Opinion in Pulmonary Medicine, 18(3): 213-221
Døllner, H., Ramm, C.T., Harstad, I., Afset, J.E., Sagvik, E. (2012) Risk of developing tuberculosis after brief exposure in Norwegian children: results of a contact investigation. BMJ Open, 2(6): e001816
el Baghdadi, J., Grant, A.-V., Sabri, A., el Azbaoui, S., Zaidi, H., Cobat, A., Schurr, E., Boisson-Dupuis, S., Casanova, J.-L., Abel, L. (2013) Human genetics of tuberculosis. Pathologie Biologie, 61(1): 11-16
Fischer, G.B., Andrade, C.F., Lima, J.B. (2011) Pleural Tuberculosis in Children. Paediatric Respiratory Reviews, 12(1): 27-30
Goletti, D., Stefania, C., Butera, O., Amicosante, M., Ernst, M., Sauzullo, I., Vullo, V., Cirillo, D., Borroni, E., Markova, R., Drenska, R., Dominguez, J., Latorre, I., Angeletti, C. (2008) Accuracy of Immunodiagnostic Tests for Active Tuberculosis Using Single and Combined Results: A Multicenter TBNET-Study. PLoS One, 3(10): e3417
González, S.N., Macías, P.M., Hernández, P.M., Gutiérrez, C.P., Gómez, T.V., Juárez, O.H. (2014) Pulmonary Tuberculous: Symptoms, diagnosis and treatment. 19-year experience in a third level pediatric hospital. BMC Infectious Diseases, 14(1): 401
Gyawali, N., Gurung, R., Poudyal, N., Amatya, R., Niraula, S.R., Jha, P., i dr. (2012) Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors. Nepal Med Coll J, 14(4): 303-7
Hafizi, H., Aliko, A., Sharra, E., Fico, A., Migliori, G.B., Castiglia, P., Sotgiu, G. (2014) Results of a tuberculin skin testing survey in Albania. Journal of Infection in Developing Countries, 8(3): 310-4
Hamzaoui, A., Yaalaoui, S., Tritar, C.F., Slim, S.L., Berraies, A. (2014) Childhood tuberculosis: a concern of the modern world. European Respiratory Review, 23(133): 278-291
Institute for Public Health 'Dr Milan Jovanović Batut' (2014) The number of cases and deaths from infectious diseases. Available from: o%20zaraznim%20bolestima%202014.pdf
Jia, Z., Cheng, S., Ma, Y., Zhang, T., Bai, L., Xu, W., He, X., Zhang, P., Zhao, J., Christiani, D.C. (2014) Tuberculosis burden in China: a high prevalence of pulmonary tuberculosis in household contacts with and without symptoms. BMC Infectious Diseases, 14(1): 64
Keys, C., McLeod, E., Pesti, C., Armstrong, D. (2012) Thoracoscopic Pleural Biopsy as an Aid to Diagnosis in Pediatric Tuberculosis with Pleural Involvement. European Journal of Pediatric Surgery, 22(04): 315-317
Kumar, P., Kumar, A., Lodha, R., Kabra, S. K. (2015) Childhood Tuberculosis in General Practice. Indian Journal of Pediatrics, 82(4): 368-374
Luo, W.X., Huang, Y., Li, Q.B., Han, J. (2014) Values of a combination of multiple less invasive or non-invasive examinations in the diagnosis of pediatric sputum-negative pulmonary tuberculosis. Zhongguo Dang Dai Er Ke Za Zhi, 16(8): 791-4 (Chinese)
Mandalakas, A. M., Detjen, A. K., Hesseling, A. C., Benedetti, A., Menzies, D. (2011) Interferon-gamma release assays and childhood tuberculosis: systematic review and meta-analysis [Review article]. International Journal of Tuberculosis and Lung Disease, 15(8): 1018-1032
Marais, B.J., Gie, R.P., Hesseling, A.C., Schaaf, H.S., Lombard, C., Enarson, D.A. (2006) A refined symptom: based approach to diagnose pulmonary tuberculosis in children. Pediatrics, 118: 1350-9
Marais, B.J. (2014) Tuberculosis in children. Journal of Paediatrics and Child Health, 50(10): 759-767
Mukherjee, A., Singh, S., Lodha, R., Singh, V., Hesseling, A. C., Grewal, H.M. S., Kabra, S.K. (2013) Ambulatory Gastric Lavages Provide Better Yields of Mycobacterium tuberculosis Than Induced Sputum in Children With Intrathoracic Tuberculosis. Pediatric Infectious Disease Journal, 32(12): 1313-1317
Nantongo, J.M., Wobudeya, E., Mupere, E., Joloba, M., Ssengooba, W., Kisembo, H.N., Lubega, I.R., Musoke, P.M. (2013) High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda. BMC Pediatrics, 13(1): 16
Nie, H., Dai, J. (2014) Clinical value of pleural biopsy in the diagnosis of children with tuberculous pleurisy. Zhonghua Er Ke Za Zhi., 52(5): 392-6 (Chinese)
Nishimura, M., Magawa, K., Matsushita, Y., Wakao, I. (2014) Importance of a symptomatic visit in tuberculosis contactsclassification of secondary cases. Kekkaku, 89(7): 667-72, (Japanese)
Rahman, N., Pedersen, K.K., Rosenfeldt, V., Johansen, I.S. (2012) Challenges in diagnosing tuberculosis in children. Dan Med J, 59(7): A4463
Ritz, N., Curtis, N. (2014) Novel concepts in the epidemiology, diagnosis and prevention of childhood tuberculosis. Swiss Medical Weekly, 144: w14000
Rutherford, M. E., Hill, P. C., Maharani, W., Apriani, L., Sampurno, H., van Crevel, R., Ruslami, R. (2012) Risk factors for Mycobacterium tuberculosis infection in Indonesian children living with a sputum smear-positive case. International Journal of Tuberculosis and Lung Disease, 16(12): 1594-1599
Sia, I.G., Buckwalter, S.P., Doerr, K.A., Lugos, S., Kramer, R., Orillaza-Chi, R., Quelapio, M.I., Tupasi, T.E., Wengenack, N.L. (2013) Genotypic characteristics of Mycobacterium tuberculosis isolated from household contacts of tuberculosis patients in the Philippines. BMC Infectious Diseases, 13(1): 571
Sloot, R., Schim, van der L.M.F., Kouw, P.M., Borgdorff, M.W. (2014) Risk of Tuberculosis after Recent Exposure. A 10-Year Follow-up Study of Contacts in Amsterdam. American Journal of Respiratory and Critical Care Medicine, 190(9): 1044-1052
Sun, L., Xiao, J., Miao, Q., Feng, W., Wu, X., Yin, Q., Jiao, W., Shen, C., Liu, F., Shen, D., Shen, A. (2011) Interferon gamma release assay in diagnosis of pediatric tuberculosis: a meta-analysis. FEMS Immunology & Medical Microbiology, 63(2): 165-173
Thanh, T.H.T., Ngoc, S.D., Viet, N.N., van Hung, N., Horby, P., Cobelens, F.G., Wertheim, H.F. (2014) A household survey on screening practices of household contacts of smear positive tuberculosis patients in Vietnam. BMC Public Health, 14(1): 713
Yassin, M.A., Petrucci, R., Garie, K.T., Harper, G., Teshome, A., Arbide, I., Asnake, G., Ahmed, H.J., Mammo, T., Yesuf, K., Cuevas, L.E. (2012) Use of tuberculin skin test, IFN-γ release assays and IFN-γ-induced protein-10 to identify children with TB infection. European Respiratory Journal, 41(3): 644-648
Yim, A.P.C., Izzat, M.B., Lee, T.W. (1999) Thoracoscopic Surgery for Pulmonary Tuberculosis. World Journal of Surgery, 23(11): 1114-1117