Tuberculosis in Children: Epidemio-Clinical Aspects in the Paediatric Department of the Gabriel TouréUniversity Hospital Center

Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.

Epidemiological, Clinical and Etiological Aspects of Adult Hepatomegaly at the Gabriel Touré University Hospital of Bamako in 2023

Summary: Hepatomegaly is one of the clinical signs commonly encountered in chronic liver disease. The aim of our study was to study the epidemiological, clinical and etiological aspects of hepatomegaly in the hepato-gastroenterology department (HGE) of the Gabriel Touré university hospital. This was a cross-sectional study that took place from September 2021 to October 2022 in the department. All patients aged 18 years and older with hepatomegaly, hospitalized or examined by physicians were included. We collected 100 cases of hepatomegaly, representing 3.7% of 2661 patients examined or hospitalized in the HGE department during the study period. These patients had a mean age was 46.7 ± 16.10 years with extremes of 18 and 76 years. The sex ratio was 2.7. Jaundice was the most commonly reported history with a frequency of 26%. Pertaining to patients’ lifestyle, alcohol consumption was the most common feature with 6%. The most common associated clinical signs were jaundice, ascites, and edema of the lower limbs. Painful hepatomegaly (86%), with a sharp lower edge (74%), a firm consistency (69%), and an irregular surface (52%) was frequently observed. Cytolysis (75.5%), increased alphafetoprotein levels (70%), microcytic anemia (37%), hyperleukocytosis (54.3%), and biological hepatocellular insufficiency syndrome (low albumin with 30.4%, high bilirubinemia with 61.2% and low platelets with 33.9%) were the most common observed laboratory abnormalities. Hepatitis B virus markers (61%) were the most frequently found in the study patients. At ultrasound examination, heterogeneous hepatomegaly was observed in 87.3% of the patients. Esophageal varices (43.1%) were more commonly seen than other varices during upper gastrointestinal endoscopy. The dominant etiology was hepatocellular carcinoma on cirrhosis with 66% followed by cirrhosis. Conclusion: Painful hepatomegaly was quite frequently in our urban setting hospital with several etiologies. HCC was the most common etiology, therefore measures to prevent it in the community need to be established by the concerned stakeholders to improve adult population health in Bamako.

Subcutaneous Emphysema Associated with Pneumomediastinum and Complicated Pneumopericardium in a 14-Month-Old Infant

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.