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Extra pulmonary tuberculosis in children

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Background: Tuberculosis is a highly contagious disease, produced by Mycobacterium tuberculosis (Koch bacillus). The evolution of this disease is chronic, consumptive, with a high mortality rate (in the absence of accurate treatment).As this case will be focused on extrapulmonary tuberculosis in children, it is necessary to mention that over 25% of patients (children) develop this complication and more than 10% of them do not survive.

Methods: We present the case of a 17 years old male with a history of operated pilocytic astrocytoma of the vermis, right cerebellum hemisphere and upper supratentorial obstructive hydrocephalus, suspected to have cysticercosis, which was admitted due to vomiting and generalized tonic-clonic seizures. Other associated symptoms were intracranial hypertension and global ataxia.Particularities of this case are the cerebral complications associated with tuberculosis, resulting in delayed treatment and no favorable outcome without a fast diagnosis.

Results: Over the course of treatment, the patient required ventriculo-peritoneal shunting, aggressive antibiotics, along with anti-inflammatory and anti-thermic medication. After performing multiple computed tomographies and cerebrospinal fluid examinations over the course of 4 weeks, the suspected final diagnosis of pulmonary tuberculosis and secondary meningo-encephalitis was confirmed, the patient was transferred to a regional hospital in order to undergo adequate treatment.

Conclusion: Over 9.6 million people have contracted tuberculosis in 2015, and over 25% of infected children also developed extra-pulmonary tuberculosis. In absence of prompt and adequate treatment, the mortality rates of this disease will rise (1.7 million deaths in 2015). Furthermore, prophylactic methods and their importance should be better explained to the population, in order to avoid contacting such an aggressive and consumptive disease.

Abreviations: CRP – C reactive protein, CSF – Cerebro-spinal fluid, CT – Computed Tomography, GCS – Glasgow Coma Scale, GI – Gastro-intestinal, AST – Aspartateaminotransferase, ALT – Alaninaminotransferase, Hb – Hemoglobin, HCT – Hematocrit, SP O2 – O2 saturation, TB – Tuberculosis, WBC – White Blood Cells, WCBC – White Blood Cell Count

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Cristina Ramona Sutu, Rodica Olimpia Tudoran, Mihaela I. Ciocan and Catalina G. Popovici

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