Exploring the Link Between Primary Immunodeficiency and Severity of Tuberculosis in Children: A Prospective Observational Study
Sushant Mane, Kaif Charania, Manas Pustake, Farheena Ansari, Aneesh Kulkarni, Rohit KukadeAbstract
Background:
Tuberculosis (TB) in children may present with severe or atypical forms such as disseminated, recurrent, or drug-resistant disease, raising the possibility of underlying immunological abnormalities. This study aimed to evaluate the immunological profile of children with these forms of TB and explore potential associations with disease severity, if any.
Materials and Methods:
This prospective, observational pilot study was conducted in a tertiary care teaching hospital. Fifty children aged 6 months to 18 years with microbiologically confirmed disseminated TB or recurrent TB were enrolled. Clinical, microbiological, and immunological evaluations were performed, including lymphocyte subset analysis, immunoglobulin levels, nitroblue tetrazolium test, and selected advanced immunological assays.
Results:
The mean (±SD) age of participants was 11.64 (±8.06) years, with 56% males. Disseminated TB was the most common presentation (52%), followed by pulmonary TB (38%). Drug-resistant TB was observed in 70% of patients. Most patients had immunological parameters within normal ranges, although statistically significant differences were observed in selected lymphocyte subsets and immunoglobulin levels across disease categories. Only one patient (2%) was diagnosed with primary immunodeficiency (Mendelian susceptibility to mycobacterial disease).
Conclusion:
Immunological variations were observed in children with severe forms of TB; however, primary immunodeficiency was uncommon in this cohort. These findings suggest that routine immunological screening may have limited yield but could be considered in selected high-risk cases. Larger studies are needed to further explore the clinical significance of the findings of this study.