Tuberculose chez l’Enfant : Aspects Cliniques et Thérapeutiques au Service de Pédiatrie de l’Hôpital National de Donka

RESUME Introduction. De diagnostic difficile chez l’enfant, la tuberculose est responsable de nombreux deces chez les moins de 15 ans dans les pays en developpement. L’objectif de notre travail etait de decrire les differents aspects de la tuberculose de l’enfant au service de pediatrie de l’Hopital National Donka. Methodes. Etude transversale retrospective, descriptive sur 5 ans consistant en une revue des dossiers d’enfants âges de 0-15 ans, traites pour tuberculose dans le service de pediatrie de l’Hopital National Donka (Conakry). Les donnees etaient collectees a partir des registres de suivi et des dossiers medicaux. Etaient inclus, les enfants ayant un dossier medical complet, le diagnostic de la tuberculose etait base sur la presence de faisceaux d’arguments anamnestiques, cliniques, biologiques et radiologiques. Resultats. Nous avons collige 397 cas de tuberculose parmi 17204 patients hospitalises (2,3%) dont 57,2% de garcons, soit un sex-ratio M/F de 1,33. L’âge moyen des patients etait de 5 mois. Le contage a la tuberculose a ete evoque chez 167 enfants (43,04%) et l'IDR etait positive chez 257 enfants (62.24%). Le BK a ete recherche chez 48 enfants avec 18.75% de positifs. Les localisations mediastinopulmonaires et ganglionnaires ont ete observees dans 314 cas (80.93%). Il y a eu 328 enfants gueris (84,54%). Parmi les enfants malades, il y a eu 39 perdus de vue (10,05%) et 21 (5,41 %) deces. Parmi eux, 13(61,9%) avaient moins de 5 ans. Conclusion. La tuberculose de l’enfant est un probleme de sante publique en Guinee, du fait de son tableau clinique riche et polymorphe. Son diagnostic biologique reste difficile. Les localisations mediastinopulmonaires et ganglionnaires sont les plus frequentes. L’evolution est favorable pour la majorite des patients. ABSTRACT Introduction. Tuberculosis is a public health problem that is responsible of many deaths in children under 15 years in developing countries. Its diagnosis is difficult in children. The aim of our study was to describe the clinical aspects, the treatment modalities and the outcome in our setting. Methods. This was a cross sectional retrospective, 5-year descriptive study consisting of a review of children aged 0-15 years treated for tuberculosis in the Donka pediatric ward. Data were collected from medical records. We included only children with complete medical record. The diagnosis of tuberculosis was based on the combination of anamnestic, clinical, biological and radiological evidences. Results. We found 397 cases of tuberculosis (57.2% of boys) out of 17204 inpatients (2.3%). The average age was 5 months. Contage was reported in 167 children (43.04%). Tuberculin test was positive in 62.24% of patients. Mycobacterium tuberculosae was searched in 48 children and was found in 18.75% of them. Lung, mediastinum and lymphatic nods were more the most common locations. Complete healing was observed in 328 patients (84.54%). In our study group, 39 children (10.05%) were lost to follow-up and 21 (5.41%) died. Among them, 13(61.9%) were aged 5 years or less. Conclusion. Tuberculosis is a health problem in Guinea, by its rich and polymorphic clinical picture, its biological diagnosis remains random. Lung, mediastinum and lymphatic nods are the most common sites. The outcome is usually favorable.