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KMID : 0367419690100050001
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Journal of Korean Pediatric Society
1969 Volume.10 No. 5 p.1 ~ p.13
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A Clinical and Statistical Analysis of Tuberculosis in Children from Poor Families in Pusan Area of Korea
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金晟澤/Kim, S.T.
裵鍾三/趙宗大/金大成/趙璋濟/金贊榮/Bae, J.S./Cho, C.D./Kim, D.S./Cho, J.J./Kim, C.Y.
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Abstract
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Introduction
At present the infection rate of tuberculosis in Korea is 65% of total population according to the survey of Korean National Tuberculosis Association in 1965, and the morbidity rate is 5.1% of total population, roughly numbering 1.24 million with tuberculosis and 24,000 people are dead each year from this disease.
The source of tuberculosis infection in children is mostly from open tuberculosis in adults who infect their household contacts, as described in most texts and articles.
The authors tried to find such children infected or suffering from tuberculosis in poor families in the Pusan area, and gave treatment at S.C.F. clinics. Here we report the clinical charateristics and source of tuberculosis infection whenever found among household contacts.
Study Material and Method
A total of 830 cases of tuberculosis, under 15 years, from poor families were subjected to study; they were registered at 2 S.C.F. clinics for tuberculosis, between Jan. 1964 and June 1966. Diagnostic procedures included tuberculin testing, radiography, gastric lavage, and sputum examination. And for many of those children diagnosed as having tuberculosis mass x-rays, tuberculin testing and sputum examinations were used for household contacts, as much as possible. Home visiting was done by a qualified nurse before or during treatment to evaluate economic and environmental condition, and to find household contacts.
The classification of tuberculosis used was according to that in Nelson´s textbook of pediatrics. The media used for AFB culture was that of Ogawa, and the criteria of drug resistance was determined as resistant strain when more than 50% of colonies were grown in the media of INH 5.0?/ml, PAS 10?/ml, SM 10?/ml, Thiacetazone 5.0?/ml, comparing with those of control media.
Result and Discussion
1) Incidence
830 patients with tuberculosis were found among a total of 14,205 children attending out-patient clinics, so that 5.8% were tuberculous. This rate is a little higher than the 4.3% of tuberculosis in adults attending out-patient clinics in Korea, but much higher than the 1.2% of total out-patients in Japan, 1960.
Among these 830 cases of tuberculosis, 91 children(11%) were discovered as having tuberculosis by positive reading after routine tuberculin testing at Dong offices. Doing sch simple routine tuberculin testing is a very important way of finding early tuberculosis. Also 13 cases(1.56%) infected with tuberculosis were found among children previously receiving B.C.G. vaccination. This is in agreement with Hatcher´s report in which tuberculosis was found in 1% (3 out of 309 children) after B.C.G. vaccination. Without doubt a B.C.G. vaccination dose a great deal to prevent tuberculosis in young children at present in Korea.
Assuming that children from poor families in urban areas have much chance to be in contavt with heavy sources of infection, it is probably best to do B.C.G. vaccination immediately after birth or during the first month of life.
2) Age and Sex disrtibution
95 cases(11.4%) were inder 1 year and 385 cases(46.4%) between 1 and 3 years; 57.8% of total number were under 3 year and 78.2% were under 6 year.
450 children (54.2%) were male and 380 children were female, showing slight sexual difference, perhaps due to mothers; greater concern for male babies.
The majority of promary tuberculosis was found in younger children; 95 cases of active tuberculosis were found in infants suggesting that there might be many open tuberculosis cases in poor family households who were infecting their close contacts.
3) Classification according to lesions
151 patients(18.15) out of the total of 830 cases had multiple tuberculosis lesions more than 2 sites in the same patient. Dividing the cases into intrathoracic and extrathoracic lesions, 69% were intra and 31% extrathoracic cases. This showed a remarkable difference from the findings in a Japanese report, in which 5.6% were extrathoracic lesions. The defference may be due to different intake policy at the two centers.
The most common intrathoracic lesions were (1) hilar adenitis alone(33.5%) (2) children under 3 years with positive tuberculin tests only(9.8%) (3) non-calcified pulmonary focus only(8.5%). All of the lesions were primary tuberculosis in the under 6 year age group. Miliary tuberculosis and tuberculosis meningitis were found more often in younger children from 1 to 6 year of age. In infants 3 cases of miliary tuberculosis and 7 cases of tuberculosis meningitis were detected. Adult type of ledions such as apical tuberculosis lesions and extensive pulmonary infiltration were found not only in the older children but also in early childhood(See Table 3).
Many cases of multiple tuberculosis lesions occurred in the same child, frequently observed conversion from tuberculin negative to tuberculin positive in infants and younger children and common miliary tuberculosis and tuberculous menigitis in these children, indicated that heavy tuberculous infection occurred in the family and household contacts in early life, especially in families with poor nutrition and living close together in small houses under inhygienic conditions.
4) Positive AFB cultures
AFB was found by cultures from gastric lavage, sputum, and other specimens from 115 children out of 492 chldren from whom specimens for culture were obtained, revealing 23.4%.
The culture of gastric in 28 cases (14%). This result was similar to the 13.8% of Pratt, but much higher than Roye´s, who got positive results in only 8 out of 1207 cases. And Choi, in Korea, reported 20% of positive results from culturing gastric lavage material tuberculous children in 1966.
Of the 28 cases with positive AFB culture from gastric lavage material, 17 (70.8%) had heavy infection such as extensive pulmonary infinltration, miliary tuberculosis or bronchopneumonia; 11(29.2%) had mild infection such as a non-calcified pulmonary focus;
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