Características clínicas e epidemiológicas da tuberculose em crianças e adolescentes

Sousa, George Jó Bezerra; Silva, Julio Cesar de Oliveira; Queiroz, Talita Vaz de; Bravo, Lia Guedes; Brito, Gizelly Castelo Branco; Pereira, Aline de Souza; Pereira, Maria Lúcia Duarte; Santos, Luciana Kelly Ximenes dos

doi:10.1590/0034-7167-2018-0172

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (5) • Sep-Oct 2019 • https://doi.org/10.1590/0034-7167-2018-0172 copiar

Características clínicas e epidemiológicas da tuberculose em crianças e adolescentes

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Analisar as características clínicas e epidemiológicas da tuberculose em crianças e adolescentes de um hospital de referência em doenças infecciosas.

Método:

Foi realizado um estudo documental e retrospectivo com 88 prontuários médicos em um hospital de referência em doenças infecciosas no estado do Ceará. Os dados foram analisados através das abordagens univariada, bivariada e multivariada.

Resultados:

Verificou-se que, dependendo do tipo de tuberculose, suas manifestações podem variar. O modelo de regressão logística considerou apenas a tuberculose pulmonar devido a um número de observações e incluiu sexo feminino (IC 95%: 1,4-16,3), perda de peso (IC 95%: 1,8-26,3) e baciloscopia (IC 95%: 1,5-16,6) com coleta de escarro (IC95%: 1,4-19,4) como possíveis preditores.

Conclusão:

Crianças e adolescentes apresentam diferentes manifestações da doença dependendo do tipo de tuberculose que os afeta. Conhecer as características mais comuns de cada condição pode melhorar o diagnóstico precoce e, consequentemente, levar a tratamentos e cuidados adequados.

Descritores:
Tuberculose; Criança; Adolescentes; Epidemiologia; Enfermagem Pediátrica

Features	Pulmonary TB		p value	Odds Ratio (95%CI)
Features	No (%)	Yes (%)	p value	Odds Ratio (95%CI)
Sex (Female)^* * chi-square;	11 (28.2)	28 (71.8)	0.03	2.65 (1.08-6.48)
Age Range (>10 years old)^* * chi-square;	29 (39.2)	45 (60.8)	0.45	1.55 (0.49-4.88)
Skin Color (Pardo)^* * chi-square; ^a	25 (39.1)	39 (60.9)	0.56	1.32 (0.51-3.40)
Precedence (from Fortaleza)^* * chi-square;	11 (39.3)	17 (60.7)	0.83	1.10 (0.44-2.75)
Basic Sanitation^† † Fisher's exact test;	19 (46.3)	22 (53.7)	1.00	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Fever^* * chi-square;	23 (35.4)	42 (64.6)	0.07	2.37 (0.90-6.25)
Expectoration^* * chi-square;	15 (27.3)	40 (72.7)	0.001	4.66 (1.85-11.76)
Weight Loss^* * chi-square;	5 (17.9)	23 (82.1)	0.003	4.91(1.65-14.64)
Dyspnoea^* * chi-square;	5 (33.3)	10 (66.7)	0.51	1.47 (0.45-4.75)
Lymph Nodes Alteration^† † Fisher's exact test;	6 (100.0)	0 (00.0)	0.004	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
HIV^† † Fisher's exact test;	4 (57.1)	3 (42.9)	0.43	0.49 (0.10-2.33)
Comorbidities^* * chi-square;	14 (43.8)	18 (56.2)	0.68	0.83 (0.34-2.00)
Previous TB treatment^* * chi-square;	13 (37.1)	22 (62.9)	0.55	1.29 (0.54-3.11)
Bacilloscopic screening^* * chi-square;	11 (22.4)	38 (77.6)	<0.001	6.16 (2.41-15.74)
Mycobacterium culture^* * chi-square;	23 (45.1)	28 (54.9)	0.34	0.65 (0.27-1.57)
Tuberculin skin test^* * chi-square;	17 (47.2)	19 (52.8)	0.31	0.64 (0.27-1.52)
Sputum collected^* * chi-square;	15 (26.3)	42 (73.7)	<0.001	5.88 (2.26-15.30)
Bronchoalveolar liquid collected^† † Fisher's exact test;	0 (00.0)	4 (100.0)	0.14	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Outcome (hospital discharge)^* * chi-square;	30 (41.1)	43 (58.9)	0.93	0.95 (0.30-2.96)

Features	Extrapulmonary TB		p value	Odds Ratio (95%CI)
Features	No (%)	Yes (%)	p value	Odds Ratio (95%CI)
Sex (Female)^* * Chi-square;	33 (84.6)	6 (15.4)	0.06	0.37 (0.13-1.07)
Age Range ( >10 years old)^* * Chi-square;	57 (77.0)	17 (23)	0.31	0.53 (0.15-1.81)
Skin Color (Pardo)^* * Chi-square;	47 (73.4)	17 (26.6)	0.58	1.37 (0.44-4.25)
Precedence (from Fortaleza)^* * Chi-square;	17 (60.7)	11 (39.3)	0.03	2.88 (1.05-7.84)
Basic Sanitation^† † Fisher's exact test;	30 (73.2)	11 (26.8)	1.00	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Fever^* * Chi-square;	51 (78.5)	14 (21.5)	0.20	0.51 (0.18-1.45)
Expectoration^* * Chi-square;	49 (89.1)	6 (10.9)	<0.001	0.13 (0.04-0.38)
Weight Loss^† † Fisher's exact test;	25 (89.3)	3 (10.7)	0.03	0.25 (0.06-0.96)
Dyspnoea^† † Fisher's exact test;	13 (86.7)	2 (13.3)	0.33	0.40 (0.08-1.97)
Lymph Nodes Alteration^† † Fisher's exact test;	0 (00.0)	6 (100.0)	<0.001	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
HIV^† † Fisher's exact test;	7 (100.0)	0 (00.0)	0.18	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Comorbidities^* * Chi-square;	24 (75.0)	8 (25.0)	1.00	1.00 (0.36-2.72)
Previous TB treatment^† † Fisher's exact test;	32 (91.4)	3 (8.6)	0.005	0.16 (0.04-0.62)
Bacilloscopic screening^* * Chi-square;	42 (85.7)	7 (14.3)	0.009	0.26 (0.09-0.74)
Mycobacterium culture^* * Chi-square;	35 (68.6)	16 (31.4)	0.10	2.36 (0.82-6.78)
Tuberculin skin test^* * Chi-square;	22 (61.1)	14 (38.9)	0.01	3.5 (1.27-9.59)
Sputum collected^* * Chi-square;	50 (87.7)	7 (12.3)	<0.001	0.14 (0.05-0.43)
Bronchoalveolar liquid collected^† † Fisher's exact test;	4 (100.0)	0 (00.0)	0.56	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Outcome (hospital discharge) ^† † Fisher's exact test;	53 (72.6)	20 (27.4)	0.33	2.45 (0.50-11.85)

Features	Mixed-type TB		p value	Odds Ratio (95%CI)
Features	No (%)	Yes (%)	p value	Odds Ratio (95%CI)
Sex (Female) ^† † Fisher's exact test;	35 (89.7)	4 (10.3)	0.74	0.68 (0.18-2.53)
Age Range ( > 10 years old) ^† † Fisher's exact test;	65 (87.8)	9 (12.2)	1.00	0.83 (0.15-4.33)
Skin Color (Pardo)^* * chi-square;	59 (92.2)	5 (7.8)	0.03	0.25 (0.06-0.93)
Precedence (from Fortaleza)^† † Fisher's exact test;	28 (100.0)	0 (00.0)	0.01	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Basic Sanitation^† † Fisher's exact test;	34 (82.9)	7 (17.1)	1.00	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Fever^† † Fisher's exact test;	57 (87.7)	8 (12.3)	1.00	0.93 (0.22-3.87)
Expectoration^† † Fisher's exact test;	48 (87.3)	4 (12.7)	1.00	1.05 (0.28-3.92)
Weight Loss^† † Fisher's exact test;	26 (92.9)	2 (7.1)	0.49	0.43 (0.88-2.16)
Dyspnoea^† † Fisher's exact test;	12 (80.0)	3 (20.0)	0.39	2.03 (0.47-8.77)
Lymph Nodes Alteration^† † Fisher's exact test;	6 (100.0)	0 (00.0)	1.00	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
HIV^† † Fisher's exact test;	3 (42.9)	4 (57.1)	0.004	14.09 (2.61-76.06)
Comorbidities^* * chi-square;	27 (84.4)	5 (15.6)	0.50	1.54 (0.43-5.52)
Previous TB treatment^† † Fisher's exact test;	28 (80.0)	7 (20.0)	0.10	3.06 (0.82-11.38)
Bacilloscopic screening^† † Fisher's exact test;	46 (93.9)	3 (6.1)	0.05	0.25 (0.06-1.02)
Mycobacterium culture^* * chi-square;	46 (90.2)	5 (9.8)	0.36	0.56 (0.15-2.00)
Tuberculin skin test^† † Fisher's exact test;	34 (94.4)	2 (5.6)	0.18	0.28 (0.05-1.38)
Sputum collected^* * chi-square;	51 (89.5)	6 (10.5)	0.44	0.61 (0.17-2.19)
Bronchoalveolar liquid collected^† † Fisher's exact test;	4 (100.0)	0 (00.0)	1.00	^‡ ‡ Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Outcome (hospital discharge) ^† † Fisher's exact test;	64 (87.7)	9 (12.3)	1.00	0.91 (0.17-4.73)

Features^* * Fisher's exact test;	Drug-Resistant TB		p value	Odds Ratio (95%CI)
Features^* * Fisher's exact test;	No (%)	Yes (%)	p value	Odds Ratio (95%CI)
Sex (Female)	38 (97.4)	1 (2.6)	1.00	0.61 (0.05-7.08)
Age Range ( > 10 years old)	71 (95.9)	3 (4.1)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Skin Color (Pardo)	61 (95.3)	3 (4.7)	0.55	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Precedence (from Fortaleza)	28 (100.0)	0 (00.0)	0.54	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Basic Sanitation	40 (97.6)	1 (2.4)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Fever	64 (98.5)	1 (1.5)	0.16	0.16 (0.01-1.90)
Expectoration	53 (96.4)	2 (3.6)	1.00	1.20 (0.10-13.85)
Weight Loss	28 (100.0)	0 (00.0)	0.54	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Dyspnoea	15 (100.0)	0 (00.0)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Lymph Nodes Alteration	6 (100.0)	0 (00.0)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
HIV	7 (100.0)	0 (00.0)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Comorbidities	31 (96.9)	1 (3.1)	1.00	0.87 (0.07-10.0)
Previous TB treatment	32 (91.4)	3 (8.6)	0.06	1.09 (0.98-1.21)
Bacilloscopic screening	48 (98.0)	1 (2.0)	0.58	0.38 (0.03-4.41)
Mycobacterium culture	49 (96.1)	2 (3.9)	1.00	1.46 (0.12-16.83)
Tuberculin skin test	35 (97.2)	1 (2.8)	1.00	0.71 (0.06-8.18)
Sputum collected	55 (96.5)	2 (3.5)	1.00	1.09 (0.09-12.53)
Bronchoalveolar liquid collected	4 (100.0)	0 (00.0)	1.00	^† † Not possible to calculate due to low values in the matrix; TB - Tuberculosis.
Outcome (hospital discharge)	72 (98.6)	1 (1.4)	0.07	0.09 (0.00-1.06)

			Odds Ratio (95%CI)
	B	P	Exp. (B)	Lower	Upper
Pulmonary TB*
Constant	-2.73	<0.001
Sex (Female)	1.56	0.013	4.7	1.4	16.3
Weight Loss (Yes)	1.93	0.004	6.9	1.8	26.3
Bacilloscopic screening (Yes)	1.62	0.008	5.0	1.5	16.6
Sputum collected (Yes)	1.67	0.012	5.3	1.4	19.4

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[1] Corresponding Author: George Jó Bezerra Sousa E-mail: georgejobs@hotmail.com