Miliary TB in children and adolescents: a scoping review

OBJECTIVE To summarise the available literature regarding clinical presentation, immunological and microbiological diagnosis, treatment, and outcomes of miliary TB in children and adolescents. METHODS Four databases were searched from 1 January 1950 to 31 January 2023. "Miliary" and "...

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Bibliographic Details
Published in:The international journal of tuberculosis and lung disease 2024-09, Vol.28 (9), p.412-418
Main Authors: Buonsenso, D., Mariani, F., Morello, R., Song, R.
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Best practice
Brain
Central nervous system
Child
Child, Preschool
Children
Clinical outcomes
Diagnosis
Humans
Immunology
Medical imaging
Medical screening
Mortality
Nervous system
Neuroimaging
Paediatric Tb
Pediatrics
Sensitivity analysis
Skin tests
Teenagers
Tuberculin
Tuberculin Test
Tuberculosis
Tuberculosis, Miliary - diagnosis
Tuberculosis, Miliary - mortality
Vaccination
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Summary:OBJECTIVE To summarise the available literature regarding clinical presentation, immunological and microbiological diagnosis, treatment, and outcomes of miliary TB in children and adolescents. METHODS Four databases were searched from 1 January 1950 to 31 January 2023. "Miliary" and "disseminated" TB were the main search concepts. FINDINGS Of 257 studies, 1,883 patients with miliary TB were included. Bacille Calmette-Guérin (BCG) vaccination was confirmed in 223/549 (40.6%) children. Central nervous system (CNS) involvement was reported in 367/924 (39.7%) cases; many of them had no neurological symptoms despite also having abnormal brain imaging. Of 1,112 children with known outcomes, 341 (30.6%) died; mortality was higher in publications before 1995 (41.5%) and in children with CNS involvement (31.9%). TB microbiological confirmation (55.8%) and sensitivity of tuberculin skin test (46.9%) and QuantiFERON Gold (72.4%) were overall low. CONCLUSIONS Evidence is lacking to support best practices for paediatric miliary TB. Whether lumbar puncture (LP) and brain imaging should both be routinely done in miliary TB children, or a step-by-step approach based on initial LP findings, remains unclear. This study should inform policymakers and funding agencies about current significant gaps that need to be addressed by future high-quality studies.
ISSN:1027-3719
1815-7920
1815-7920
DOI:10.5588/ijtld.24.0106