Bacilliferous pulmonary tuberculosis of the infant: Report of 3 cases in the pediatrics department of the hospital of Mali

Introduction: Tuberculosis is one of the top ten killers worldwide. In 2015, an estimated one million children developed the disease and 170,000 died from it. We report three cases of pulmonary tuberculosis in infants diagnosed and treated in the pediatric ward of the Mali Hospital.
Clinical cases: Observation 1: He is a 7 month old infant hospitalized for fever and weight loss. He received the BCG. There was no notion of TB contagion. On admission, he had poor nutritional status with a Zscore <- 3 and pallor. He had bronchial groans. Xpert / RIF returned positive to M. tuberculosis sensitive to rifampicin. An anti-tuberculosis treatment (2RHZ / 4RH) associated with the transfusion of the globular concentrate at a rate of 20 ml / Kg / 1d over 1 hour and nutritional management have been instituted. After 2 months of treatment, we observed clinical radiological improvement. Xpert control of gastric fluid returned negative.
Observation 2: He was an 8-month-old infant hospitalized for fever and weight loss. He did not receive BCG. There was no notion of family storytelling. On admission, he had a poor nutritional status with a Z score <-3. The respiratory rate was 32 cycles / min. There were crackling groans. Direct gastric fluid examination and Xpert / RIF were positive for M. tuberculosis sensitive to rifampicin. He could not be treated because the family requested discharge against all medical advice.
Observation 3: He was a 10 month old infant admitted for cough, fever and weight loss. He received the BCG, there was the notion of family contagion. At the entrance, he had a poor nutritional status with a zscore <- 3. He had a polypnea at 45 / min and crackling groans. Direct examination and culture of gastric fluid were positive for rifampicin-sensitive M. tuberculosis. A treatment including oxygen, anti-tuberculosis drugs (2RHZ / 4RH) and nutritional management was initiated. Within 2 months of treatment, we observed clinical and radiological improvement. Direct examination and culture of gastric fluid returned negative.
Conclusion: tuberculosis in infants is poorly documented because of unspecific symptoms and difficulties in obtaining bacteriological confirmation. It should be systematically sought in all malnourished infants in endemic countries.