PMID- 23271443
OWN - NLM
STAT- MEDLINE
DCOM- 20140508
LR  - 20130710
IS  - 1532-0987 (Electronic)
IS  - 0891-3668 (Linking)
VI  - 32
IP  - 5
DP  - 2013 May
TI  - Paradoxical reaction during tuberculosis treatment in immunocompetent children: 
      clinical spectrum and risk factors.
PG  - 446-9
LID - 10.1097/INF.0b013e3182846c4e [doi]
AB  - BACKGROUND: Paradoxical reaction (PR) during antituberculosis (TB) therapy, 
      defined as clinical or radiologic worsening of preexisting TB lesions or the 
      development of new lesions, has not been widely studied in immunocompetent 
      children. METHODS: All children (<17 years) with the diagnosis of TB who sought 
      care at our center between 1994 and 2007 were included in this retrospective 
      study. Data on demographic characteristics, bacteriologic results, medical 
      imaging, treatment regimens and outcomes were abstracted from medical records. 
      Patients with and without PR were compared. RESULTS: Of 115 TB cases, 12 (10.3%) 
      developed PR. Children with PR were younger than those with TB without 
      complication: median age at diagnosis was 26 months (range, 5-148) compared with 
      66 months (range, 6-205) for those without complications (P = 0.013). None of the 
      children in the PR group had received Calmette-Guerin bacillus vaccination, 
      compared with 34 of 103 (33%) children without PR (P = 0.017). Children with a 
      diagnosis of PR were more frequently symptomatic at diagnosis of TB disease when 
      compared with children without PR (P = 0.028). PR occurred at a median interval 
      of 39 days (range, 15-75) after initiation of antituberculosis treatment. The 
      most common PR was worsening of preexisting pulmonary lesions (75%). New lesions 
      in anatomical sites other than those observed at initial presentation developed 
      in 3 children. CONCLUSION: Paradoxical deterioration during treatment of TB 
      disease is common in immunocompetent children. Young age and absence of 
      Calmette-Guerin bacillus vaccination appeared to be associated with PR.
FAU - Olive, Carole
AU  - Olive C
AD  - Pediatric, Department, CHU Saint-Pierre, Brussels, Belgium.
FAU - Mouchet, Francoise
AU  - Mouchet F
FAU - Toppet, Veronique
AU  - Toppet V
FAU - Haelterman, Edwige
AU  - Haelterman E
FAU - Levy, Jack
AU  - Levy J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pediatr Infect Dis J
JT  - The Pediatric infectious disease journal
JID - 8701858
RN  - 0 (Antitubercular Agents)
RN  - 0 (BCG Vaccine)
SB  - IM
MH  - Adolescent
MH  - Antitubercular Agents/therapeutic use
MH  - BCG Vaccine/therapeutic use
MH  - Chi-Square Distribution
MH  - Child
MH  - Child, Preschool
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Immunocompetence
MH  - Male
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Tuberculosis/diagnosis/*drug therapy/*immunology
EDAT- 2012/12/29 06:00
MHDA- 2014/05/09 06:00
CRDT- 2012/12/29 06:00
PHST- 2012/12/29 06:00 [entrez]
PHST- 2012/12/29 06:00 [pubmed]
PHST- 2014/05/09 06:00 [medline]
AID - 10.1097/INF.0b013e3182846c4e [doi]
PST - ppublish
SO  - Pediatr Infect Dis J. 2013 May;32(5):446-9. doi: 10.1097/INF.0b013e3182846c4e.