We sought to determine the incidence and clinical spectrum of the paradoxical reaction (PR) to treatment in 1000 children with tuberculosis (TB). Its incidence was 3.3%, presenting as mediastinal adenopathy (n = 12), central nervous system (CNS) tuberculoma (n = 8), increasing size of lymph nodes (n = 8) and serositis (n = 5). Symptoms included breathlessness (n = 7, 21.2%), neck swellings (n = 5, 15.2%), hemiplegia (n = 3, 9.1%), raised intracranial tension (n = 2, 6.1%) and fever or diabetes insipidus (n = 1, 3% each). The mean age of onset of PR was 3.5 months after the start of anti-TB medication. PR was seen predominantly in boys. Mediastinal lymphadenopathy was more common in children aged <2 years. Tuberculomas were more common in children aged 2–5 years. Nodal enlargement and serositis were seen equally in all age groups.
ChengVCHoPLLeeRA. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis2002; 21: 803–809.
2.
ChengVCYamWCWooPC. Risk factors for development of paradoxical response during antituberculosis therapy in HIV negative patients. Eur J Clin Microbiol Infect Dis2003; 22: 597–602.
3.
CorbellaXCarratalaJRufiG. Unusual manifestations of miliary tuberculosis: cutaneous lesions, phalanx osteomyelitis, and paradoxical expansion of tenosynovitis. Clin Infect Dis1993; 16: 179–180.
4.
AfghaniBLiebermanJM. Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis1994; 19: 1092–1099.
5.
ChienJWJohnsonJL. Paradoxical reactions in HIV and pulmonary TB. Chest1998; 114: 933–936.
6.
HillARMateoFHudakA. Transient exacerbation of tuberculous lymphadenitis during chemotherapy in patients with AIDS. Clin Infect Dis1994; 19: 774–776.
7.
OnwubaliliJKScottGMSmithH. Acute respiratory distress related to chemotherapy of advanced pulmonary tuberculosis: a study of two cases and review of the literature. Q J Med1986; 59: 599–610.
8.
BarssP. Unexpected deaths in pulmonary tuberculosis. Lancet1983; i: 1437–1437.
9.
HawkeyCRYapTPereiraJ. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clin Infect Dis2005; 40: 1368–1371.
10.
JungJWShinJWKimJY. Risk factors for development of paradoxical response during anti-tuberculosis treatment in HIV-negative patients with pleural tuberculosis. Tohoku J Exp Med2011; 223: 199–204.
11.
GuptaMBajajBKKhwajaG. Paradoxical response in patients with CNS tuberculosis. J Assoc Physicians India2003; 51: 257–260.
12.
BreenRSmithCBettisonH. Paradoxical reactions during tuberculosis treatment in patients with and without HIV co-infection. Thorax2004; 59: 704–707.
13.
NaritaMAshkinDHollenderES. Paradoxical worsening of tuberculosis following anti-retroviral therapy in patients with AIDS. Am J Respir Crit Care Med1998; 158: 157–161.
14.
ShahI. Immune Reconstitution Syndrome in HIV-1 infected children - a study from India. Indian J Pediatr2011; 78: 540–543.
15.
MorenoCTaverneJMehlertA. Lipoarabinomannan from Mycobacterium tuberculosis induces the production of tumor necrosis factor from human and murine macrophages. Clin Exp Immunol1989; 76: 240–245.
16.
WallisRSAmir-TahmassebMEllnerJJ. Induction of interleukin 1 and tumor necrosis factor by mycobacterial proteins: the monocyte Western blot. Proc Natl Acad Sci USA1990; 87: 3348–3352.
17.
SongEJBaekDHJungJY. Paradoxical response developed during the antituberculous treatment intuberculous pleurisy. Tuberc Respir Dis2008; 64: 427–432.
18.
ChoOHParkKHKimT. Paradoxical responses in non-HIV-infected patients with peripheral lymph node tuberculosis. J Infect2009; 59: 56–61.
19.
DasturDKManghaniDKUdaniPM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am1995; 33: 733–752.
20.
CampbellIADysonAJ. Lymph node tuberculosis: a comparison of various methods of treatment. Tubercle1977; 58: 171–179.
21.
Al-MajedSA. Study of paradoxical response to chemotherapy in tuberculous pleural effusion. Respir Med1996; 90: 211–214.
22.
DooleyDPCarpenterJLRademacherS. Adjunctive corticosteroid therapy for tuberculosis: a critical reappraisal of the literature. Clin Infect Dis1997; 25: 872–887.
23.
ShahIMeshramL. High dose versus low dose steroids in children with tuberculous meningitis. J Clin Neurosci2014; 21: 761–764.
24.
EvansDJ. The use of adjunctive corticosteroids in the treatment of pericardial, pleural and meningeal tuberculosis: do they improve outcome?Respir Med2008; 102: 793–800.
