Clinical characteristics and prognostic outcomes of pediatric tuberculosis in a tertiary care center in China: a 10-year retrospective cohort

• Distinct age-related clinical patterns were observed in pediatric tuberculosis (TB) cases. • None of the child household contacts received TB preventive treatment before TB onset. • Infants showed the highest drug-induced liver injury rate (31%) and mortality (13.3%). • Microbiological diagnosis reduced the risk of loss to follow-up before treatment end. • TB meningitis significantly increased mortality among pediatric patients. This study aims to investigate the clinical features and prognostic outcomes of pediatric tuberculosis (TB) in Shenzhen. This retrospective study collected demographic, clinical, laboratory, and prognostic data from pediatric patients diagnosed with TB between January 2013 and January 2023. Multivariable regression identified risk factors for loss to follow-up and mortality. A total of 358 children were included, and distinct age-related patterns were observed. Younger children had more extrapulmonary TB, whereas older children were more likely to develop pulmonary cavities. Nearly half (47.6%) of the children aged 0-1 years were household contacts of patients with TB, but none of the children had received TB preventive treatment before disease onset. Infants showed the highest rates of drug-induced liver injury (31%) and mortality (13.3%). Microbiological diagnosis was associated with reduced risk of loss to follow-up before treatment completion (hazard ratio 0.463, 95% confidence interval 0.248-0.863, P = 0.015). Tuberculous meningitis significantly increased mortality risk (hazard ratio 10.830, 95% confidence interval 1.214-96.645, P = 0.033). Pediatric TB presents with diverse clinical features across age groups. Early microbiological diagnosis and attention to high-risk populations, especially infants and those with TB meningitis, are essential for improving treatment outcomes. TB preventive treatment in exposed children remains critically underused.