Risk Factors of Extrapulmonary Tuberculosis in Children

Background: Tuberculosis (TB) continues to result in high morbidity and mortality in children from resource-limited settings. Extrapulmonary TB had several of clinical appearance and complications. Hence it is important to identify the risk factors for early detection and treatment. The objective of this study is to identify factors associated with extrapulmonary TB in children. Methods: Observational study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. Data was collected from medical records of patients who were diagnosed with extrapulmonary TB, aged 1-18 years old in the period of 2010-2018. Data were collected as risk factors were age, nutritional status, BCG (Bacille Calmette Guerin) immunization status, contact history with adult TB patients, and HIV (human immunodeficiency virus) infection. Each risk factor was analyzed using Chi-square. Risk factors which were statistically significant (p<0,05) would be analyzed using logistic regression. Results: There were 362 patients diagnosed with extrapulmonary TB. More than a half of them are male (50,6%) and >5 years old (52,8%). Most of them already got BCG immunization (72,9%) and had normal nutritional status (73,9%). Lymphadenitis TB, bone/joint TB and miliary TB were the most extrapulmonary TB in this study. Factors associated with extra pulmonary TB were age (PR 0.51; 95% CI=0.38-0.68; p<0.001), nutritional status (PR 3.14; 95% CI=2.29-4.29; p<0.001), and HIV infection (PR 3.66; 95% CI=2.21-6.06; p<0.001). In multivariate analysis, age, nutritional status, and HIV infection were statistically significant associated with extrapulmonary (Exp(B) 1.921; 0.326; 0.274; respectively p<0.001). Conclusion: Age, nutritional status, and HIV infections are risk factors of extrapulmonary TB in children.