ENT organ tuberculosis in the practice of a pediatrician: A retrospective study

Background. Despite a decline in the overall incidence of tuberculosis, the diagnosis and treatment of extrapulmonary forms remain challenging. The rarity of these manifestations, combined with limited clinician awareness, reduces pediatricians' and related specialists' vigilance, hindering timely detection. Diagnosis of extrapulmonary forms of the disease is difficult due to their oligobacillary nature and the difficulty of obtaining samples suitable for culture and molecular genetic confirmation. Extrapulmonary localizations of tuberculosis are secondary manifestations of the disease. When pulmonary forms are detected, the possibility of concomitant involvement of other organs and systems is often underestimated. In the Russian and international literature, single clinical cases of ENT organ tuberculosis are presented, mostly in the context of the development of generalized severe forms.

Aim. To actualize the problem of ENT organ tuberculosis in children, drawing the attention of specialists to its clinical importance, despite the overall decrease in the incidence of tuberculosis.

Materials and methods. A retrospective review of medical records from 668 patients aged 0 to 3 years who were treated in the therapeutic pulmonary pediatric department of the Moscow Research and Clinical Center for Tuberculosis Control over the past 15 years was conducted.

Results. ENT organ tuberculosis was diagnosed in 10 children (1.5% of the cohort). Patient ages ranged from 1 month 21 days to 1 year 9 months (mean 12 ± 1.85 months), with nearly twice as many boys as girls (7 boys, 4 girls). All patients exhibited generalized disease: one patient (0.15%) had involvement of two organs, six patients (0.9%) had involvement of three organs, and, in rare cases (0.15% each), four or five organs were involved. Contact with a tuberculosis patient was identified in seven children (1.05%), with the mother as the source in five cases (0.07%) (including two mothers with concurrent HIV infection) and other relatives (father, uncle) in two cases. The source of infection was not identified in three patients. BCG-M vaccination was given to 6 children (0.9% of the total sample); the remaining patients had a medical exemption or parental refusal. Middle ear involvement was the most common clinical manifestation, observed in seven patients (1.05% of the total sample and 70% of the group with ENT organ tuberculosis), and was mainly complicated by anthritis or mastoiditis in four patients (0.6% of the total sample and 40% of the group with ENT organ tuberculosis). In the remaining three cases, tuberculosis of the larynx and pharynx was detected.

Conclusion. Suspicion of tuberculosis necessitates a comprehensive evaluation, including a detailed history of BCG vaccination, contact with tuberculosis patients, and risk factors, as well as follow-up monitoring of disease progression, radiographic findings, and immunodiagnostic testing. Diagnosis of ENT tuberculosis should be established as early as possible, ideally within one month of symptom onset. It is essential to obtain samples for morphological analysis, assess the rate of tissue destruction, and determine the sequence of structural involvement in the pathological process. It is necessary to promptly include tuberculosis in the differential diagnosis, especially in cases of slowly progressing lesions of any localization that are not responding to standard treatment.