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Cardiac tamponade in tuberculous pericarditis: A case report
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Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
Conclusion: Atypical or prolonged respiratory symptoms should alert the physician, and clinical and radiological findings should be carefully evaluated for a possible foreign body aspiration. P96N Cardiac tamponade in tuberculous pericarditis: A case report N. Kaswandani, D.B. Setyanto, B. Supriyatno. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Pericarditis is an uncommon manifestation of TB. Pericarditis TB may cause pericardial effusion that leads to cardiac tamponade. Objective: To present the diagnosis and management cardiac tamponade in pericarditis TB. Case illustration: A 17 years-old boy came to Ciptomangunkusumo Hospital with the chief complaint of progressively worsen dyspnea since 3 days before admission. The patients also complained the occurrence of a nodule at the superior chest. The nodule was soft and firmed no tenderness and no redness. Since 2 weeks before admission he felt fever, productive cough and decreased appetite. History of TB contact was the neighbor with pulmonary TB. Physical examination found that he was severely ill with dyspnea, fever and pale. The chest examination found a fluctuative mass without inflammation. His heart sound was soft and diminished, but no gallop or murmur. Breath sound was weak at the right field. The chest radiography showed cardiomegaly and hyllar lymp node enlargement while the echocardiography showed massive pericardial effusion and collapse of the right atrium. The patients was diagnosed as cardiac tamponade et causa massive pericardial effusion/pericarditis TB, chest wall TB, anemia and undernourished. The patient was performed pericardiocentesis and anti TB drugs RHZE plus prednisone was given. Pericardial fluid analysis showed exudates with polimorphonuclear dominant and positive AFB. The patient was discharged in 3rd week in a good condition. Discussion: The diagnosis of cardiac tamponade pericarditis TB in this patient was supported by clinical findings, chest X-ray and echocardiography. Pericardiocentesis and pericardial drainage which was immediately performed improved the clinical condition of the patient. Anti TB treatment was given as WHO recommendation for AFB positive category. Conclusion: Percarditis TB can accumulate the massive fluid that leads to cardiac tamponade. An immediate pericardial drainage will improve the clinical condition of the patient. P97N Clinical features of respiratory diseases in children with HIV N. Kaswandani, D.B. Setyanto, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Respiratory diseases are the most common opportunistic infection in HIV positive children. Diagnosis of certain disease such as tuberculosis is difficult in HIV-positive children due to the less specific symptoms and less sensitive tuberculin skin test. Objective: To define the prevalence of respiratory diseases and to know the clinical feature of respiratory diseases in children with HIV. Methods: Cross-sectional study carried out in Ciptomangunkusumo Hospital Jakarta. The subjects were all patients with HIV diagnosed January 2005-July 2009. Result: We investigated 186 HIV-infected children with the aged 31.5±2.64 months. Tuberculosis was the most frequent respiratory diseases (39.2%), followed by upper ARI (25.3%), pneumonia (17.2%) and otitis media (14.5%). Fifty-nine (31.7%) subjects has a good nutritional status, while 88 (47.3%) were moderate malnourished and 39 (21%) subjects were severe malnourished. Subjects were mostly (56%) in severe immunosupression status. Contacts with adult TB were found in 54 (29%) subjects. Most children (53.2%) complained of chronic recurrent cough. Chronic fever, difficulty in
weight gain and anorexia were occurred in 37.8%, 41.2%, and 31.4% subjects respectively. Sixty-five children (34.9%) had lymph node enlargement. We identified 86 subjects performed TST and 13 of them (15%) showed indurations 5 mm and more. Chest radiograph found infiltrates in most subject (37.2%), followed by combination of hillar lymph node enlargement and infiltrates (36%). Atelectasis and consolidation were found in 3 patients. Conclusion: The prevalence of TB in children with HIV was 39.2%. The most common symptoms were chronic recurrent cough, fever and difficulty in weight gain. Tuberculin skin test was positive in some children with HIV. P98N Comparison of PCR and tuberculin skin test for TB diagnosis in children D.B. Setyanto, N. Kaswandani, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Diagnosis of TB in children is difficult due to the less specific symptoms and difficulties in obtaining the specimen. Tuberculin skin test has been used widely to investigate the infection of TB in children, but it still has the weakness in certain subjects. Polymerase Chain Reaction (PCR) is currently used to support the diagnosis TB, but it still limited data in children. Objective: To compare the accuracy of PCR and TST in diagnosis TB in children. Method: It was a diagnostic study to evaluate the accuracy of PCR in diagnosing childhood TB. The patient aged 0–15 years were recruited and evaluated for TB. The subjects did the TST, PCR and AFB direct smear and culture. The specimens were obtained from sputum or gastric lavage. The gold standard was the positive result of smear and/or culture of Mycobacterium tuberculosis. Result: One hundred and twenty-five subjects were evaluated for TB. The positive AFB and/or culture were found in 27 subjects. Among 27 confirmed TB patients, TST were positive in 16 subjects (sensitivity 59.3%) while PCR were positive in 15 subjects (sensitivity 55.6%). The specificity, PPV and NPV of TST were 56.1%, 27.1% and 83.3% respectively while the specificity, PPV and NPV of PCR were 63.3%, 36.6% and 83.8% respectively. Conclusion: For diagnosing TB in children, PCR did not show the superiority in diagnostic values compared to Tuberculin Skin Test. The larger study in children is needed to have the more powerful result. P99N Correlation between nasal peak inspiratory flow (NIPF) and peak expiratory flow (PFE) C.A.C. Leandro, C.D.C. Ibiapina. Universidade federal de Minas Gerais pediatrician – Belo Horizonte, Brazil Keywords: Rhinitis, nasal, flow, children
Statement of the purpose of the study: The present work has as an objective correlate the measures of the expiratory flow peak (PFE), with the nasal peak inspiratory flow (NIPF ), in a healthy pediatric population. Description of the methods used: A concurrent cohort study was carried out in public schools in Brasil, with 300 randomly selected patients aged six to sixteen in a healthy pediatric population. Correlations between NIPF and PFE were obtained from linear regression using the Pearson’s correlation coefficient (r). Summary of the results: Moderate but statistically significant correlation between PFE and NIPF was found (r = −0.394; p ≤ 0.001) Conclusion: The results indicate a moderate correlation between NIPF and PFE. The PFE value is a predictable informative of the NIPF and that the bigger the PEF is, the bigger is the NIPF. Reflections and Concrete proposals for action: The asthma and the allergic rhinitis are sickness of extreme importance in the public health, and their prevalency excites the global world. Objective measures as the peak of the nasal inspiratory flow (NIPF) and the
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
Conclusion: Atypical or prolonged respiratory symptoms should alert the physician, and clinical and radiological findings should be carefully evaluated for a possible foreign body aspiration. P96N Cardiac tamponade in tuberculous pericarditis: A case report N. Kaswandani, D.B. Setyanto, B. Supriyatno. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Pericarditis is an uncommon manifestation of TB. Pericarditis TB may cause pericardial effusion that leads to cardiac tamponade. Objective: To present the diagnosis and management cardiac tamponade in pericarditis TB. Case illustration: A 17 years-old boy came to Ciptomangunkusumo Hospital with the chief complaint of progressively worsen dyspnea since 3 days before admission. The patients also complained the occurrence of a nodule at the superior chest. The nodule was soft and firmed no tenderness and no redness. Since 2 weeks before admission he felt fever, productive cough and decreased appetite. History of TB contact was the neighbor with pulmonary TB. Physical examination found that he was severely ill with dyspnea, fever and pale. The chest examination found a fluctuative mass without inflammation. His heart sound was soft and diminished, but no gallop or murmur. Breath sound was weak at the right field. The chest radiography showed cardiomegaly and hyllar lymp node enlargement while the echocardiography showed massive pericardial effusion and collapse of the right atrium. The patients was diagnosed as cardiac tamponade et causa massive pericardial effusion/pericarditis TB, chest wall TB, anemia and undernourished. The patient was performed pericardiocentesis and anti TB drugs RHZE plus prednisone was given. Pericardial fluid analysis showed exudates with polimorphonuclear dominant and positive AFB. The patient was discharged in 3rd week in a good condition. Discussion: The diagnosis of cardiac tamponade pericarditis TB in this patient was supported by clinical findings, chest X-ray and echocardiography. Pericardiocentesis and pericardial drainage which was immediately performed improved the clinical condition of the patient. Anti TB treatment was given as WHO recommendation for AFB positive category. Conclusion: Percarditis TB can accumulate the massive fluid that leads to cardiac tamponade. An immediate pericardial drainage will improve the clinical condition of the patient. P97N Clinical features of respiratory diseases in children with HIV N. Kaswandani, D.B. Setyanto, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Respiratory diseases are the most common opportunistic infection in HIV positive children. Diagnosis of certain disease such as tuberculosis is difficult in HIV-positive children due to the less specific symptoms and less sensitive tuberculin skin test. Objective: To define the prevalence of respiratory diseases and to know the clinical feature of respiratory diseases in children with HIV. Methods: Cross-sectional study carried out in Ciptomangunkusumo Hospital Jakarta. The subjects were all patients with HIV diagnosed January 2005-July 2009. Result: We investigated 186 HIV-infected children with the aged 31.5±2.64 months. Tuberculosis was the most frequent respiratory diseases (39.2%), followed by upper ARI (25.3%), pneumonia (17.2%) and otitis media (14.5%). Fifty-nine (31.7%) subjects has a good nutritional status, while 88 (47.3%) were moderate malnourished and 39 (21%) subjects were severe malnourished. Subjects were mostly (56%) in severe immunosupression status. Contacts with adult TB were found in 54 (29%) subjects. Most children (53.2%) complained of chronic recurrent cough. Chronic fever, difficulty in
weight gain and anorexia were occurred in 37.8%, 41.2%, and 31.4% subjects respectively. Sixty-five children (34.9%) had lymph node enlargement. We identified 86 subjects performed TST and 13 of them (15%) showed indurations 5 mm and more. Chest radiograph found infiltrates in most subject (37.2%), followed by combination of hillar lymph node enlargement and infiltrates (36%). Atelectasis and consolidation were found in 3 patients. Conclusion: The prevalence of TB in children with HIV was 39.2%. The most common symptoms were chronic recurrent cough, fever and difficulty in weight gain. Tuberculin skin test was positive in some children with HIV. P98N Comparison of PCR and tuberculin skin test for TB diagnosis in children D.B. Setyanto, N. Kaswandani, N.N. Rahajoe. University of Jakarta, Faculty of Medicine, Department of Child Health – Jakarta, Indonesia Background: Diagnosis of TB in children is difficult due to the less specific symptoms and difficulties in obtaining the specimen. Tuberculin skin test has been used widely to investigate the infection of TB in children, but it still has the weakness in certain subjects. Polymerase Chain Reaction (PCR) is currently used to support the diagnosis TB, but it still limited data in children. Objective: To compare the accuracy of PCR and TST in diagnosis TB in children. Method: It was a diagnostic study to evaluate the accuracy of PCR in diagnosing childhood TB. The patient aged 0–15 years were recruited and evaluated for TB. The subjects did the TST, PCR and AFB direct smear and culture. The specimens were obtained from sputum or gastric lavage. The gold standard was the positive result of smear and/or culture of Mycobacterium tuberculosis. Result: One hundred and twenty-five subjects were evaluated for TB. The positive AFB and/or culture were found in 27 subjects. Among 27 confirmed TB patients, TST were positive in 16 subjects (sensitivity 59.3%) while PCR were positive in 15 subjects (sensitivity 55.6%). The specificity, PPV and NPV of TST were 56.1%, 27.1% and 83.3% respectively while the specificity, PPV and NPV of PCR were 63.3%, 36.6% and 83.8% respectively. Conclusion: For diagnosing TB in children, PCR did not show the superiority in diagnostic values compared to Tuberculin Skin Test. The larger study in children is needed to have the more powerful result. P99N Correlation between nasal peak inspiratory flow (NIPF) and peak expiratory flow (PFE) C.A.C. Leandro, C.D.C. Ibiapina. Universidade federal de Minas Gerais pediatrician – Belo Horizonte, Brazil Keywords: Rhinitis, nasal, flow, children
Statement of the purpose of the study: The present work has as an objective correlate the measures of the expiratory flow peak (PFE), with the nasal peak inspiratory flow (NIPF ), in a healthy pediatric population. Description of the methods used: A concurrent cohort study was carried out in public schools in Brasil, with 300 randomly selected patients aged six to sixteen in a healthy pediatric population. Correlations between NIPF and PFE were obtained from linear regression using the Pearson’s correlation coefficient (r). Summary of the results: Moderate but statistically significant correlation between PFE and NIPF was found (r = −0.394; p ≤ 0.001) Conclusion: The results indicate a moderate correlation between NIPF and PFE. The PFE value is a predictable informative of the NIPF and that the bigger the PEF is, the bigger is the NIPF. Reflections and Concrete proposals for action: The asthma and the allergic rhinitis are sickness of extreme importance in the public health, and their prevalency excites the global world. Objective measures as the peak of the nasal inspiratory flow (NIPF) and the