Clinical practice

Abstract

Childhood tuberculosis (TB) represents an important part of the disease burden, yet its diagnosis remains challenging. This review summarizes the clinical, radiological, and bacteriological approaches to diagnose TB infection and disease in children. Fever (possibly intermittent or low grade), weight loss or failure to thrive, and a persistent cough for >2 weeks are the most important clinical signs for pulmonary tuberculosis. Extra-pulmonary TB, which might occur in over 40% of the patients, can have in addition some specific clinical symptoms or signs. Chest radiographs provide important information in many patients and advanced imaging can be applied in case of (and should be restricted to) inconclusive diagnosis. The Mantoux test is positive in up to 70% of non-immunocompromised TB patients, whereas HIV co-infection or malnourishment results in a lower reactivity. Evidence of an adult TB index case is clue for diagnosis of childhood TB in low-endemic countries. Bacteriological confirmation remains difficult and is useful for doubtful cases or when drug resistance is suspected.

Granulysin-Expressing CD4+ T Cells as Candidate Immune Marker for Tuberculosis during Childhood and Adolescence

“…This elevated granulysin remained high in individuals newly diagnosed with active TB ( p <0.001) or LTBI ( p <0.01) as compared to controls (Figure 2C). Better measures for diagnosis of childhood TB are urgently needed [11]. Our data favour a 7-day in vitro restimulation assay for TB diagnosis in children.…”

“…T cell-based interferon-gamma (IFNγ) release assays (IGRAs) offer some advantages [8], [9], [10]. The most deterministic factors of possible Mycobacterium tuberculosis (Mtb) infection in children, include compatible clinical signs and symptoms, an X-ray indicative of TB and likelihood of infection due to known contact [11].…”

Pott's disease in Moroccan children: clinical features and investigation of the interleukin-12/interferon-γ pathway

“…Microbiological investigations are commonly negative in TS patients, due to the paucibacillary nature of childhood extra-pulmonary TB. TST is of limited diagnostic value, particularly in areas of endemic TB with high coverage rates for BCG vaccination 23 , as in Morocco. Positive TST results were obtained for only four of the seven patients tested.…”

Primary tooth abscess caused by Mycobacterium bovis in an immunocompetent child

“…The inclusion of tuberculosis in the differential diagnosis of unclear pulmonary and extrapulmonary disease remains important, and tuberculosis has to be managed according to international standards [7]. Although, childhood tuberculosis represents an important part of the disease burden, yet its diagnosis remains challenging [9]. The application of molecular genetic techniques that can easily differentiate tubercle bacilli belonging to MTBC could also specify the true prevalence of M. bovis infections that are currently underestimated.…”