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KMID : 1130320180610110366
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Korean Journal of Pediatrics
2018 Volume.61 No. 11 p.366 ~ p.370
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A contact investigation after exposure to a child with disseminated tuberculosis mimicking inflammatory bowel disease
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Kim Dong-Sub
Lee So-Dam
Kang Sang-Hee
Park Mi-Sun
Yoo So-Young
Jeon Tae-Yeon
Choi Joon-Sik
Kim Bo-Ra
Choi Jong-Rim
Cho Sun-Young
Chung Doo-Ryeon
Choe Yon-Ho
Kim Yae-Jean
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Abstract
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Purpose: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals.
Methods: A 4-year-old child without Bacille Calmette-Guerin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts.
Results: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB.
Conclusion: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.
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KEYWORD
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Disseminated tuberculosis, Inflammatory bowel disease, Contact investigation
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