{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T07:49:40Z","timestamp":1762674580250,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T00:00:00Z","timestamp":1653523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Each year, approximately two million adolescents and young adults in the world become infected with tuberculosis (TB). The problem is that the classification of the disease includes children in the age group 0\u201314 years and young adults aged 15 and over. The present study aims to analyze and compare the epidemiology and clinical presentation of TB in Bulgaria in the different age subgroups of childhood. Methods: A retrospective study was undertaken of the newly diagnosed children (n = 80) with TB treated onsite from January 2018 to December 2020 at the Multiprofile Hospital for Active Treatment of Pulmonary Diseases (\u201cSt. Sofia\u201d). They were distributed into three age groups: aged 8\u201311 (prepuberty), aged 12\u201314 (younger adolescents), and aged above 15 (older adolescents). Results: A clear finding of the research indicated that adolescent children develop TB both as primary and secondary infections. In a large number of cases with the children under our care, we found enlarged intrathoracic lymph nodes as well as infiltrative changes in the lungs, i.e., we observed transitional forms. There were statistically significant differences between the age group &gt;15 years old and each of the other two younger groups for diagnosis, the severity of intoxication, and BK spreading status. Conclusion: The course of tuberculosis in adolescence has its own specifics and differences between the three age groups in the current study.<\/jats:p>","DOI":"10.3390\/children9060785","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T08:50:22Z","timestamp":1653555022000},"page":"785","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tuberculosis in Adolescents in Bulgaria for a Three-Year Period: 2018\u20132020"],"prefix":"10.3390","volume":"9","author":[{"given":"Natalia","family":"Gabrovska","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Specialized Hospital for Active Treatment of Children\u2019s Diseases \u201cProf. Ivan Mitev\u201d, Medical University\u2013Sofia, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albena","family":"Spasova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Specialized Hospital for Active Treatment of Children\u2019s Diseases \u201cProf. Ivan Mitev\u201d, Medical University\u2013Sofia, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anabela","family":"Galacheva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Specialized Hospital for Active Treatment of Children\u2019s Diseases \u201cProf. Ivan Mitev\u201d, Medical University\u2013Sofia, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitar","family":"Kostadinov","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases \u201cSt. Sofia\u201d, Medical University\u2013Sofia, 1431 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolay","family":"Yanev","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases \u201cSt. Sofia\u201d, Medical University\u2013Sofia, 1431 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Milanov","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases \u201cSt. Sofia\u201d, Medical University\u2013Sofia, 1431 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaloyan","family":"Gabrovski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital \u201cSt. Ivan Rilski\u201d, Medical University\u2013Sofia, 1431 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-2798","authenticated-orcid":false,"given":"Svetlana","family":"Velizarova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Specialized Hospital for Active Treatment of Children\u2019s Diseases \u201cProf. Ivan Mitev\u201d, Medical University\u2013Sofia, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.3389\/fimmu.2018.02946","article-title":"The Wonder Years: What Can Primary School Children Teach Us about Immunity to Mycobacterium tuberculosis?","volume":"9","author":"Seddon","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_2","unstructured":"ECDS (2022, March 20). Tuberculosis Surveillance and Monitoring in Europe, Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/tuberculosis-surveillance-and-monitoring-europe-2022-2020-data."},{"key":"ref_3","unstructured":"WHO (2022, May 18). Global Tuberculosis Report 2021, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240037021."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1702352","DOI":"10.1183\/13993003.02352-2017","article-title":"The incidence of tuberculosis among adolescents and young adults: A global estimate","volume":"51","author":"Snow","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S2352-4642(19)30337-2","article-title":"Adolescent tuberculosis","volume":"4","author":"Snow","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/INF.0b013e3182933214","article-title":"Adolescents with tuberculosis: A review of 145 cases","volume":"32","author":"Cruz","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/01.inf.0000237919.53123.f4","article-title":"Tuberculosis in adolescents: A French retrospective study of 52 cases","volume":"25","author":"Pontual","year":"2006","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1016\/S0140-6736(19)30308-3","article-title":"Tuberculosis","volume":"393","author":"Furin","year":"2019","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1183\/09031936.00111812","article-title":"Assessing spatial heterogeneity of multidrug-resistant tuberculosis in a high-burden country","volume":"42","author":"Jenkins","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2471\/BLT.12.104588","article-title":"Multidrug-resistant tuberculosis in Belarus: The size of the problem and associated risk factors","volume":"91","author":"Skrahina","year":"2012","journal-title":"Bull. World Health Organ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1800176","DOI":"10.1183\/13993003.00176-2018","article-title":"Adolescents and young adults: A neglected population group for tuberculosis surveillance","volume":"51","author":"Schaaf","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_12","unstructured":"National Statistical Institute (NSI) (2022, March 20). Healthcare, Available online: https:\/\/www.nsi.bg\/bg\/content\/14521."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"651","DOI":"10.5588\/ijtld.16.0866","article-title":"Tuberculosis in adolescents and young adults: Epidemiology and treatment outcomes in the Western Cape","volume":"21","author":"Snow","year":"2017","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mulongeni, P., Hermans, S., Caldwell, J., Bekker, L.-G., Wood, R., and Kaplan, R. (2019). HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0210937"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chiang, S.S., Dolynska, M., Rybak, N.R., Cruz, A.T., Aibana, O., Sheremeta, Y., Petrenko, V., Mamotenko, A., Terleieva, I., and Horsburgh, R.C. (2020). Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine. ERJ Open Res., 6.","DOI":"10.1183\/23120541.00308-2020"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1016\/S0140-6736(10)60580-6","article-title":"Age and the epidemiology and pathogenesis of tuberculosis","volume":"375","author":"Donald","year":"2010","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2147\/IDR.S45090","article-title":"Epidemiology and disease burden of tuberculosis in children: A global perspective","volume":"7","author":"Shingadia","year":"2014","journal-title":"Infect. Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1086\/589750","article-title":"Rates of tuberculosis transmission to children and adolescents in a community with a high prevalence of HIV infection among adults","volume":"47","author":"Middelkoop","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"851","DOI":"10.4314\/ahs.v15i3.20","article-title":"Prevalence and risk factors of latent Tuberculosis among adolescents in rural Eastern Uganda","volume":"15","author":"Verver","year":"2015","journal-title":"Afr. Health Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1056\/NEJMra1008049","article-title":"Tuberculosis in children","volume":"367","author":"Marais","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1183\/09031936.00133613","article-title":"Paediatric tuberculosis in Europe: Lessons from Denmark and inclusive strategies to consider","volume":"43","author":"Marais","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5588\/pha.11.0010","article-title":"Incomplete registration and reporting of culture-confirmed childhood tuberculosis diagnosed in hospital","volume":"1","author":"Schaaf","year":"2011","journal-title":"Public Health Action"},{"key":"ref_23","first-page":"111","article-title":"Tuberculose em adolescentes em duas capitais brasileiras (Port) [Tuberculosis among adolescents in Brazilian capitals]","volume":"29","author":"Schmidt","year":"2013","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_24","unstructured":"WHO (2014). Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/02724930091995","article-title":"The clinical and radiological features of tuberculosis in adolescents","volume":"20","author":"Weber","year":"2000","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_26","unstructured":"Rib\u00f3n, W. (2017). Diagnosis of Tuberculosis among Children and Adolescents, Mycobacterium\u2014Research and Development, IntechOpen."},{"key":"ref_27","unstructured":"Grahan, S. (2016). The Union\u2019s Desk Guide for Diagnosis and Management of Tuberculosis in Children, IUATLD. [3rd ed.]."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/6\/785\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:19:15Z","timestamp":1760138355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/6\/785"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,26]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["children9060785"],"URL":"https:\/\/doi.org\/10.3390\/children9060785","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,5,26]]}}}