{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:05:03Z","timestamp":1789376703443,"version":"build-2803163510"},"reference-count":66,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Pediatric tuberculosis (TB) remains diagnostically challenging because of nonspecific presentations and the frequent absence of microbiological confirmation. We aimed to characterize pediatric TB patients presenting to a non-specialized tertiary hospital in Romania and to explore factors associated with bacteriological confirmation. We retrospectively analyzed children diagnosed with TB between 2017 and 2025 at a tertiary pediatric hospital in Bucharest. Clinical, epidemiological, laboratory, radiological, microbiological, and follow-up data were evaluated. Factors associated with bacteriological confirmation were assessed using univariate and exploratory multivariable analyses. Among 48 patients, the median age was 14 years (IQR 8.25\u201316), and 37.5% of cases were bacteriologically confirmed. Initial presentations were pleural effusion (47.9%), pneumonia (41.7%), and cavitary disease (10.4%). No patient with pleural effusion had a documented TB contact, compared with 45.0% with pneumonia and 40.0% with cavitary disease (p &lt; 0.001). Bacteriologically confirmed patients were older and more frequently had cavitary lesions. In exploratory Firth penalized logistic regression, older age and the presence of cavitary lesions remained associated with bacteriological confirmation. Pediatric TB may mimic common respiratory diseases even without known TB contact. In exploratory Firth penalized logistic regression, older age and cavitary lesions were associated with bacteriological confirmation, although the estimates, particularly for cavitary lesions, were imprecise and should be interpreted cautiously, while the substantial proportion of clinically diagnosed cases highlights the importance of integrating clinical, radiological, immunological, and microbiological findings.<\/jats:p>","DOI":"10.3390\/microorganisms14092042","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T08:10:23Z","timestamp":1789373423000},"page":"2042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Tuberculosis Outside a Specialized TB Center: Clinical Presentation, Diagnostic Pathways, and Factors Associated with Microbiological Confirmation in a Romanian Tertiary Hospital"],"prefix":"10.3390","volume":"14","author":[{"given":"Alexandru-Ioan","family":"Ulmeanu","sequence":"first","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatrics, Emergency Hospital for Children \u2018\u2019Grigore Alexandrescu\u201d, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8008-4408","authenticated-orcid":false,"given":"Alexandru","family":"Dinulescu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatrics, Emergency Hospital for Children \u2018\u2019Grigore Alexandrescu\u201d, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2784-5635","authenticated-orcid":false,"given":"Andrei-Vlad","family":"Totu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatrics, Emergency Hospital for Children \u2018\u2019Grigore Alexandrescu\u201d, 011743 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Ion Alexandru","family":"Voropanov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pediatric Pneumology, \u201cMarius Nasta\u201d Institute of Pneumoftiziology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100510","DOI":"10.1016\/j.jctube.2025.100510","article-title":"The Persistent Threat of Tuberculosis\u2212Why Ending TB Remains Elusive?","volume":"38","author":"Suvvari","year":"2025","journal-title":"J. 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