Tuberculous chylothorax in paediatric population-a case report and systematic review of the literature.

Autor:	Khoo MS; Department of Paediatrics, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia.; Research Centre, Universiti Kebangsaan Malaysia Children's Specialist Hospital, The National University of Malaysia, Kuala Lumpur, Malaysia., Masra F; Department of Paediatrics, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia., Ali A; Department of Paediatrics, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia.; Research Centre, Universiti Kebangsaan Malaysia Children's Specialist Hospital, The National University of Malaysia, Kuala Lumpur, Malaysia.; Institute of IR4.0, The National University of Malaysia, Bangi, Malaysia.; Infection and Immunology Health and Advanced Medicine Cluster, The National University of Malaysia, Kuala Lumpur, Malaysia.
Jazyk:	angličtina
Zdroj:	Translational pediatrics [Transl Pediatr] 2023 Jul 31; Vol. 12 (7), pp. 1439-1449. Date of Electronic Publication: 2023 Jun 21.
DOI:	10.21037/tp-22-636
Abstrakt:	Background: Chylothorax as part of the clinical spectrum of tuberculosis (TB) is a rare entity, especially among children. However, it is crucial for clinicians to be able to identify, correlate, and diagnose chylothorax as it poses significant morbidity to patients. Case Description: We report on a paediatric case of pleural TB complicated with complex chylothorax, and systematically reviewing the literature for cases of tuberculous chylothorax among children particularly looking at the (I) demographic, (II) clinical presentations, (III) radiological findings, and (IV) investigations among this cohort of patients. The systematic review complied to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used three separate databases, namely PubMed, Ovid, and Scopus to search for articles with terms "chylothorax", "tuberculosis", and "children". We included article reporting on: (I) children aged below 18; (II) infected by Mycobacterium TB , and (III) written in English only. We reviewed the publications from the inception up to August 2022. After an extensive search, 7 articles were reviewed. We included 10 patients from all the reports. Most common symptoms reported were intermittent fever (n=6) and chronic cough (n=5). Other symptoms include shortness of breath and chest discomfort due to fluid accumulation and/or effusion. Typical TB symptoms like night sweat, loss of weight, and loss of appetite were present in some of the reported patients. Chest radiography was the most used diagnostic imaging modality, in which all of the reported cases noted presence of pleural effusion, with some cases proceeded with computer tomography (CT) of thorax to aid in the diagnosis. Most of the patients had lymphadenopathies and all patients underwent pleural tapping for analysis and symptomatic relief. From the pleural fluid milky appearance and biochemistry correlation, the diagnosis of chylothorax was established in all 10 patients. Every patient was tested positive for TB infection. Conclusions: Most of the cases showed similar clinical presentation, radiological findings, and laboratory investigations particularly the classic analysis findings of pleural fluid. Even though TB is not a common cause of chylothorax, clinicians should have raised suspicion of it especially after gathering full history and correlating it with the other findings. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-636/coif). The authors have no conflicts of interest to declare. (2023 Translational Pediatrics. All rights reserved.)
Databáze:	MEDLINE
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