Tuberculosis in Adolescents, Particularly in Those Older Than 15 Years, May Present Characteristics Similar to Those of Adults

To the Editors: We read with interest the recent publication by Carril et al1 titled Adolescent Tuberculosis: 6 Years of Experience in a Tertiary Care Pediatric Hospital in Buenos Aires, Argentina. This study provides further evidence that tuberculosis in adolescents, particularly in those >15 years of age, may present characteristics like those of adults, with a higher frequency of severe pulmonary disease leading to pulmonary sequelae.1 We support and appreciate the authors' work and agree with their conclusions, but have some concerns about some of the details in the article. Adolescence is a high-risk period in a person's life for new tuberculosis infection and subsequent progression to tuberculosis disease.2 Compared to children, tuberculosis in this age group is also more easily transmissible, making adolescents considered a high-risk population for tuberculosis transmission in the community.3 Tuberculosis among adolescents has been neglected to date. However, this situation is changing, and adolescent tuberculosis has recently been recognized as a priority on the adolescent health research agenda.4 Adolescents and young adults make up a significant proportion of patients starting antituberculosis treatment, so improving treatment outcomes in this population is crucial for global tuberculosis control.5 In the issue of Pediatric Infectious Disease Journal, Carril et al retrospectively analyzed 292 tuberculosis patients aged 10–19 years admitted to the Phthisiology Department of the Children's Hospital "Dr. Ricardo Gutiérrez" (tertiary care pediatric hospital in the Autonomous City of Buenos Aires, Argentina), between January 2016 and December 2021.1 They conducted a retrospective analysis to continuously evaluate tuberculosis in adolescents (10–19 years) diagnosed with tuberculosis. Importantly, it highlights that tuberculosis in adolescents, particularly in those >15 years of age, may present characteristics like those of adults, with a higher frequency of severe pulmonary disease leading to pulmonary sequelae.1 However, these data are limited by a lack of information on follow-up, which could provide insights for clinic or even community interventions to promote adolescent engagement in tuberculosis treatment. Additionally, there may be other unconsidered factors in this study that could impact the results, such as patient lifestyles, level of education, antibiotic abuse, environmental factors (air pollution), diagnostic delays, or other comorbidities. The lack of control over other potential factors may limit the interpretability of the results. Third, the absence of an adult control group means direct comparisons or inferences cannot be made, thus suggesting a comparison with an adult tuberculosis group. Finally, the article mentions the impact of the COVID-19 pandemic on tuberculosis diagnosis and treatment but does not deeply analyze this impact. The pandemic may lead to the reallocation of medical resources, changes in patient healthcare-seeking behavior, etc., which could influence the study findings. In conclusion, before these issues are clarified, this study's findings should be interpreted cautiously. ACKNOWLEDGMENTS We thank the Department of Tuberculosis of the Fifth People's Hospital of Suzhou (The Affiliated Infectious Disease Hospital of Soochow University) who contributed to this manuscript.