Tuberculosis in Children

Abstract

The natural history and clinical expression of infection due to Mycobacterium tuberculosis differ substantially in children compared with adults. The natural history depends upon the age at infection and the host immune status. Children infected prior to age 4 have a very high rate of developing immediate clinical or radiographic manifestations or both, but are unlikely to develop reactivation disease in adulthood. In contrast, children infected in preadolescence or adolescence are more prone to developing more severe adult-type pulmonary tuberculosis soon after infection or in adulthood. It is difficult to confirm the diagnosis of tuberculosis by current microbiological methods. Even in industrialized countries, the triad of a positive tuberculin skin test, radiographic and/or clinical manifestations consistent with tuberculosis, and establishing a recent link to a known infectious case of tuberculosis is the "gold standard" for diagnosis. Children with tuberculosis respond well to and tolerate the same basic treatment regimens as used for adults. Some prevention of childhood tuberculosis can be achieved by the use of the bacille Calmette-Guérin (BCG) vaccines, but the use of chemotherapy to treat recent tuberculosis infection, discovered via contact tracing, is of paramount importance even when BCG vaccines are used.

Tuberculosis among health care workers in KwaZulu-Natal, South Africa: a retrospective cohort analysis

“…Pediatric wards are often considered to be low-risk areas as children with TB are less infectious than adults [25]. However, in this sample, we found HCWs who had a history of working in pediatric wards had an increased incidence of TB.…”

Burden of disease and risk factors for death among children treated for tuberculosis in Malawi

“…The greatest number of cases occurred in the 5–14 year age group. This age category is typically defined by lower rates of TB, 8 suggesting under diagnosis in children less than five years.…”

“…These include protean clinical presentation, the limited ability of children to produce sputum, and paucity of tuberculosis bacilli in samples that are produced. 8 Because of the rapid progression from infection to clinical disease—typically in less than 12 months—there is a limited time window for clinicians to identify children at risk of exposure and those in the early stages of disease. 8,9 HIV-infected children face unique risks because of the higher rate of household exposure to TB, faster progression from infection to disease, and the high incidence of other infections that may complicate diagnosis.…”

“…8 Because of the rapid progression from infection to clinical disease—typically in less than 12 months—there is a limited time window for clinicians to identify children at risk of exposure and those in the early stages of disease. 8,9 HIV-infected children face unique risks because of the higher rate of household exposure to TB, faster progression from infection to disease, and the high incidence of other infections that may complicate diagnosis. 10,11 Further, countries with the highest burden of tuberculosis have limited diagnostic capacity, usually relying on sputum microscopy, a test with low sensitivity in the few children who can produce specimens.…”

Tuberculosis with Pulmonary Cavitations in Two Siblings of Internally Displaced Couple– A Case Report

“…Ahidjoetal [6] reported that out of 125 children with pulmonary TB 9 were found to be having cavitary lesions given a prevalence of 7.2%. However, cavitary disease in children may result from poor containment at the site oforganism deposition in a very young and/or immune-compromised children, aspiration of live bacilli when a diseased lymphnode erupts into an airway, among those less than 5 years of age, and the third being the adulttype disease found mainly in children greater than 10 years of age [7]. Both cases presented here may have developed cavitary disease due to one of these reasons.…”