Diagnosing Tuberculosis in Children

Study Notes

Diagnosis of TB in children is challenging due to nonspecific symptoms and limited diagnostic tools.
Symptoms may include:
- Coughing, fever, and weight loss
- Lymph node enlargement
- Abnormal chest X-ray
Diagnostic tests:
- Tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) to detect latent TB infection
- Chest X-ray to rule out active TB
- Sputum or gastric aspirate smear and culture for TB bacteria
- PCR or GeneXpert for rapid diagnosis
Considerations:
- Children may not produce sputum, making diagnosis more difficult
- TB in children often presents with extrapulmonary disease (e.g., lymph node, meningitis)

BCG (Bacille Calmette-Guérin) vaccine is the most widely used vaccine against TB
Recommended for:
- Infants in high-burden countries
- Infants with increased risk of TB exposure (e.g., HIV-infected mothers)
Efficacy:
- Provides protection against severe forms of TB, such as meningitis and miliary TB
- Limited protection against pulmonary TB
Administration:
- Given at birth or as soon as possible after birth
- Booster doses not recommended

First-line treatment:
- Isoniazid (INH) and rifampicin (RIF) for 6 months
- Ethambutol (EMB) added for severe or extrapulmonary disease
Second-line treatment:
- Reserved for multidrug-resistant TB (MDR-TB) or treatment failures
- Includes medications like fluoroquinolones, aminoglycosides, and cycloserine
Dosage and duration:
- Adjusted according to age and weight
- Treatment duration may vary depending on the severity of disease and response to treatment

Increased risk of TB in HIV-infected children due to impaired immune system
Coinfection:
- TB may accelerate HIV disease progression
- HIV may increase the risk of TB treatment failure
Diagnosis and treatment:
- Same as for HIV-uninfected children, with additional consideration for antiretroviral therapy (ART)
- TB treatment may need to be adjusted based on ART interactions

Definition:
- Presence of TB bacteria in the body without symptoms or evidence of active disease
Diagnosis:
- TST or IGRA to detect latent TB infection
Treatment:
- Isoniazid (INH) for 9 months to prevent progression to active TB
- Alternative regimens may be used for children with HIV or liver disease
Importance:
- Identifying and treating latent TB infection in children can prevent future active TB disease

Diagnosis of TB in children is challenging due to nonspecific symptoms and limited diagnostic tools
Symptoms may include coughing, fever, weight loss, lymph node enlargement, and abnormal chest X-ray
Diagnostic tests include Tuberculin skin test (TST), interferon-gamma release assays (IGRAs), Chest X-ray, Sputum or gastric aspirate smear and culture, and PCR or GeneXpert
Children may not produce sputum, making diagnosis more difficult
TB in children often presents with extrapulmonary disease (e.g., lymph node, meningitis)

BCG (Bacille Calmette-Guérin) vaccine is the most widely used vaccine against TB
Recommended for infants in high-burden countries and those with increased risk of TB exposure (e.g., HIV-infected mothers)
Provides protection against severe forms of TB, such as meningitis and miliary TB
Limited protection against pulmonary TB
Given at birth or as soon as possible after birth, with no booster doses recommended

First-line treatment includes Isoniazid (INH) and rifampicin (RIF) for 6 months
Ethambutol (EMB) is added for severe or extrapulmonary disease
Second-line treatment is reserved for multidrug-resistant TB (MDR-TB) or treatment failures
Dosage and duration are adjusted according to age and weight, with treatment duration varying depending on severity of disease and response to treatment

HIV-infected children are at increased risk of TB due to impaired immune system
Coinfection of TB and HIV accelerates HIV disease progression and increases the risk of TB treatment failure
Diagnosis and treatment are the same as for HIV-uninfected children, with additional consideration for antiretroviral therapy (ART)
TB treatment may need to be adjusted based on ART interactions

Definition: presence of TB bacteria in the body without symptoms or evidence of active disease
Diagnosis involves TST or IGRA to detect latent TB infection
Treatment includes Isoniazid (INH) for 9 months to prevent progression to active TB
Alternative regimens may be used for children with HIV or liver disease
Identifying and treating latent TB infection in children can prevent future active TB disease