Retrospective clinical analysis of 205 pediatric patients with pulmonary tuberculosis

Clinical manifestations of pediatric pulmonary tuberculosis (PTB) are atypical, making diagnosis challenging. This study aims to analyze the clinical characteristics of PTB to provide constructive suggestions for the diagnosis of PTB. A retrospective analysis was conducted on pediatric patients aged 2–14 years diagnosed with PTB and admitted to our hospital from January 2015 to December 2023. Clinical information was collected to analyze the clinical symptoms and laboratory examination methods of pediatric PTB patients. Among 205 PTB patients, 58 (28.29 %) had a history of close contact with tuberculosis, 91 (44.39 %) were initially misdiagnosed, and 110 (53.66 %) had fever. High fever (>39.5 °C) was seen in 92 (44.88 %), while 187 (91.22 %) had a cough with 107 (52.20 %) coughing for more than 7 days, suggesting it may be a distinguishing feature from other respiratory infections in children. Hemoptysis occurred in 19 (9.27 %), abnormal sweating in 26 (12.68 %), cervical lymphadenopathy in 80 (39.02 %), and abdominal pain in 17 (8.29 %). There was a significant difference in cervical lymphadenopathy between 2 and 10-year-old and 11 to 14-year-old (P < 0.05). The positivity rate of sputum microbiological examination was 37.43 %, and BALF microbiological examination was 60.00 % (P < 0.05). BALF's higher yield may reflect its use in sputum-negative cases, though this warrants further study to avoid selection bias. The T-SPOT positivity rate was 88.95 %, while TST was 75.89 % (P < 0.05). T-SPOT's superior performance may stem from its specificity for M. tuberculosis antigens, unaffected by BCG vaccination. Chest CT scans showed abnormalities in 202 (98.54 %) patients (P < 0.05). Bronchoscopy revealed abnormalities in 90 (53.57 %). BALF is valuable for pathogen diagnosis, and T-SPOT and chest CT scans are highly valuable for diagnosing PTB. Comprehensive testing should be promptly conducted for suspected PTB patients. Pediatricians should consider PTB in children with prolonged fever/cough, cervical lymphadenopathy, or contact history, and prioritize BALF, T-SPOT, and chest CT for diagnosis.