Fazal-ur rahman Khan, Arshad Ali, Tariq Ayub.
Prevalence of tuberculosis in pediatric patients undergoing chest intubation.
Biomedica Jan ;26(1):30-3.

Introduction: This is a prospective cross sectional descriptive observational study. This is designed to see indications and complications of chest intubation and to see prevalence of tuberculosis in chest intubation patients. This study was carried out in the Department of Pediatrics, DHQ Teaching Hospital, Gomal Medical College, Dera Ismail Khan. In a period of two years (Jan 2007 to Dec 2008). Materials and Methods: All those patients who underwent chest intubation during the study period were included in the study analysis. After admission, a detailed history was taken and a thorough examination was performed. Investigations included X-ray chest, full blood count, ESR, analysis and culture of pleural fluid, Mantoux test and ultrasonography of chest and abdomen. Later a chest tube was placed in the relevant pleural space under local anaesthesia. Chest tube was removed when pus/fluid drainage was stopped for at least 24-48 hrs. Diagnosis of tuberculosis was based on prolonged illness, history of contact, history of measles, raised ESR, positive Mantoux test (>10mm) and poor response to appropriate antibiotics and chest intubation beyond 10-14 days, all or some in various combinations. Results: Data was analysed for age, sex, duration of illness, investigations, diagnosis, duration/complications of chest intubation, mortality during the study period and prevalence of tuberculosis in these patients. A total of 40 patients (n=40) underwent chest intubation during the study period. Twenty six (65%) patients were male and 14 (35%) were female. Four patients (10%) were less than 1 yr of age, 25 (60%) were 1-5 yr of age and 12 (30%) were above 5 yrs of age. Indications for chest intubation included pyothorax in 27 (67.5%), pneumothorax in 11 (27.5%) and pyopneumothorax in 2 (5%) patients. Seventeen patients (42.5%) were suffering from tuberculosis. The criteria for the diagnosis were positive Mantoux test (more than 10mm) in 12 patients, suggestive pleural fluid analysis in 9 patients, history of contact in 8 patients, slow response to standard antibiotic therapy and closed tube thoracostomy in 5 patients, history of measles in preceding weeks in 2 patients and suggested CT scan in 2 patients. Complications included local wound infection in 5 (12.5%), tube blockage in 2 (5%), surgical emphysema in 2 (5%) and no response to conservative measures due to pleural thickening and fibrosis in 1 (2.5%) patients. Mean duration of chest drainage was 8.1 +- 2.4 days. Conclusion: Tuberculosis is a common cause of pleural diseases and it must be considered in the differential diagnosis of pleural infections, particularly pyopneumothorax.

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