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Pediatrics |

Pulmonary Tuberculosis in Filipino Children With Congenital Heart Disease at Philippine Heart Center

Charo Francisco, MD; Encarnita Limpin, MD; Ma. Dulce Requiron-Sy, MD; Milagros Bautista, MD
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Philippine Heart Center, Quezon City, Philippines


Chest. 2013;144(4_MeetingAbstracts):779A. doi:10.1378/chest.1702950
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Abstract

SESSION TITLE: Pediatric Pulmonary Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To determine the factors associated with pulmonary tuberculosis in Filipino children with congenital heart diseases (CHD) ages 2-18 years old in a tertiary subspecialty hospital.

METHODS: This is a prospective cross sectional study. Tuberculin skin testing, chest xray, sputum Acid Fast Bacilli (AFB) smear and TB Culture were done. They were classified based on the Philippine Pediatric Society TB Concensus as to: TB negative, TB exposure, TB infection and TB disease. The following variables were included: age, sex, socioeconomic status, nutritional status, presence of a BCG scar, New York Heart Association (NYHA) classification, exposure with smoker, exposure to a known TB disease, hematocrit level, oxygen saturation, presence of pulmonic stenosis, pulmonary artery hypertension and presence of other comorbidities,

RESULTS: There were 237 patients, 137 of whom were cyanotic and 97 patients were acyanotic. Majority of patients with TB disease were cyanotic and Tetralogy of Fallot (TOF) has the most number of cases. Age and exposure to a known TB disease were significant for both. The following factors were considered significant (p=<0.5) in the development of tuberculosis in cyanotic CHD: presence of BCG scar (p=0.004) and exposure with a smoker (p=0.000). For acyanotic type, presence of pulmonic stenosis (p=0.000) and pulmonary artery hypertension (p=0.000) were significant.

CONCLUSIONS: The presence of increased carbon dioxide tension in cases of cyanotic CHD makes them prone to pulmonary tuberculosis and explained that the organism not just grow and multiply in the presence of increase oxygen content. All patients with CHD must be screened properly for tuberculosis since it increases morbidity for patients undergoing corrective surgery.

CLINICAL IMPLICATIONS: The present study identified that cyanotic CHD patients had the greater risks of acquiring pulmonary tuberculosis due to the characteristics of the organisms and the pathogenesis of the disease itself. Patients with cyanotic CHD must be screened properly for pulmonary tuberculosis since the presence of the disease increases the risk of morbidity of patients undergoing corrective surgery.

DISCLOSURE: The following authors have nothing to disclose: Charo Francisco, Encarnita Limpin, Ma. Dulce Requiron-Sy, Milagros Bautista

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