Diagnosing Tuberculosis in Children

Tuberculosis Diagnosis In Children

• 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)

TB Vaccination In Infants

• 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

Pediatric TB Treatment Options

• 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

TB In Pediatric HIV Patients

• 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

Latent TB Infection In Children

• 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

Tuberculosis Diagnosis In Children

• 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)

TB Vaccination In Infants

• 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

Pediatric TB Treatment Options

• 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

TB In Pediatric HIV Patients

• 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

Latent TB Infection In Children

• 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