Tuberculosis in Children

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Questions and Answers

What action should be taken in response to minor side effects caused by Isoniazide?

  • Change to a different medication
  • Adjust the dosage and prescribe pyridoxine (correct)
  • Increase the dosage for better effect
  • Stop the treatment immediately

Which of the following is NOT a major side effect associated with Rifampicine?

  • Nausea (correct)
  • Purpura
  • Anuria
  • Hepatitis with jaundice

In which situation is Prednisolone NOT indicated?

  • Acute hematological miliary
  • Tuberculosis of serous membranes
  • Mediastinal adenopathy with ventilation trouble
  • Severe allergic reaction to medications (correct)

What is the required action for patients experiencing optic neuritis due to Ethambutol?

<p>Completely and permanently stop the treatment (B)</p> Signup and view all the answers

Which statement correctly describes the effectiveness of the tuberculosis treatment?

<p>Includes the disappearance of general signs and appetite restoration (D)</p> Signup and view all the answers

Which factor is NOT considered a risk factor for tuberculosis?

<p>High socioeconomic status (B)</p> Signup and view all the answers

What type of tuberculosis infection is characterized as latent?

<p>Tuberculosis-infection (A)</p> Signup and view all the answers

Which agent is primarily responsible for tuberculous infections in humans?

<p>Mycobacterium tuberculosis (B)</p> Signup and view all the answers

What is the method of indirect contamination of tuberculosis?

<p>Consumption of contaminated food (C)</p> Signup and view all the answers

Which statement regarding the epidemiology of tuberculosis is correct?

<p>It is the leading infectious disease in terms of morbidity and mortality (A)</p> Signup and view all the answers

Which condition does NOT significantly affect tuberculosis severity?

<p>Lack of physical exercise (A)</p> Signup and view all the answers

What is the primary mode of direct transmission of tuberculosis?

<p>Aerosolized droplets from coughing (A)</p> Signup and view all the answers

What characterizes miliary tuberculosis?

<p>It is more common in infants, especially within the first five years. (B)</p> Signup and view all the answers

What is typically observed in the thoracic radiography of pulmonary tuberculosis?

<p>Presence of segmental opacities and possible cavitary lesions. (D)</p> Signup and view all the answers

Which laboratory finding is most associated with pleural tuberculosis?

<p>Exudate with lymphocyte predominance and protein levels over 30 g/L. (D)</p> Signup and view all the answers

For abdominal tuberculosis, which clinical feature can present diagnostic challenges?

<p>Gastrointestinal issues resembling Crohn's disease. (A)</p> Signup and view all the answers

What symptom is prominently associated with respiratory tuberculosis?

<p>Hemoptysis and cough. (D)</p> Signup and view all the answers

Which age group has the lowest incidence of pleural effusion associated with tuberculosis?

<p>Infants under 2 years. (B)</p> Signup and view all the answers

How is tuberculous meningitis typically diagnosed?

<p>Systematic lumbar puncture for analysis. (D)</p> Signup and view all the answers

What condition can be misdiagnosed as lymphoma when considering mesenteric tuberculosis?

<p>Lymphadenopathy. (B)</p> Signup and view all the answers

What is the characteristic finding in the thoracic X-ray of miliary tuberculosis?

<p>Diffuse micronodular pattern across both lung fields. (D)</p> Signup and view all the answers

Which complication can arise due to abdominal tuberculosis?

<p>Intestinal occlusion. (C)</p> Signup and view all the answers

What is the most significant characteristic of tuberculosis in children?

<p>It can affect any part of the lung. (A)</p> Signup and view all the answers

Which of the following correctly describes the immune response to inhaled BK that is not completely destroyed?

<p>Formation of a caseous necrotic lesion. (A)</p> Signup and view all the answers

What does a lymphatic and hematogenous dissemination of tuberculosis most likely result in?

<p>Acute severe tuberculosis. (A)</p> Signup and view all the answers

Which factor indicates a latent primary infection of tuberculosis?

<p>No radiological signs of tuberculosis. (C)</p> Signup and view all the answers

What type of lesions are commonly observed in the elementary lesions of tuberculosis?

<p>Leuko-fibrinous macrophagic inflammatory follicle. (B)</p> Signup and view all the answers

What is the primary radiological finding in primary tuberculosis infection?

<p>Mediastinal lymphadenopathy. (B)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with symptoms of tuberculosis?

<p>Weight gain. (B)</p> Signup and view all the answers

What is a potential consequence of caseification followed by liquefaction in TB infections?

<p>Possible reactivation of the bacteria. (D)</p> Signup and view all the answers

In a latent tuberculosis infection, which of the following characteristics would be observed?

<p>Positive IDR but absence of symptoms. (B)</p> Signup and view all the answers

What is the recommended treatment regimen for a patient with pulmonary tuberculosis that has a positive smear?

<p>2RHZE for 2 months followed by 4RH (B)</p> Signup and view all the answers

Which medication should not be prescribed without a pre-treatment ophthalmological examination?

<p>Ethambutol (C)</p> Signup and view all the answers

In the treatment of tuberculous meningitis, which is the correct treatment phase and duration?

<p>2RHZE for 2 months, then 10RH (D)</p> Signup and view all the answers

What is the maximum dosage of Isoniazide (H) per day for adults in the treatment of tuberculosis?

<p>600 mg (D)</p> Signup and view all the answers

Which of the following combinations is appropriate for treating a child weighing less than 25 kg?

<p>RHZ (75mg/50mg/150mg) (C)</p> Signup and view all the answers

What is the recommended follow-up duration for checking the weight and clinical examination post-treatment initiation?

<p>Every 2 weeks, then at 2, 5, and 6 months (B)</p> Signup and view all the answers

Which condition would require a personalized treatment due to resistance?

<p>Multi-resistant tuberculosis (C)</p> Signup and view all the answers

What is the recommended initial treatment for pleural effusion due to tuberculosis?

<p>2RHZ for 2 months followed by 4RH (C)</p> Signup and view all the answers

What is the correct maximum dose of Pyrazinamide (Z) for adults?

<p>1200 mg (B)</p> Signup and view all the answers

Which of the following is NOT a reason to conduct a pre-therapeutic assessment?

<p>Assessment of adherence (D)</p> Signup and view all the answers

Flashcards

Tuberculosis Infection (Latent Infection)

The initial stage of tuberculosis infection where the bacteria are present in the body but not causing symptoms. The immune system is able to control the infection, preventing it from spreading.

Tuberculosis Disease (Active Infection)

The active form of tuberculosis infection where the bacteria are multiplying and causing symptoms. This stage can affect the lungs, but also other parts of the body.

Pulmonary Tuberculosis

Tuberculosis that affects the lungs. It is the most common type of tuberculosis.

Extra-pulmonary Tuberculosis

Tuberculosis that affects parts of the body other than the lungs, such as the lymph nodes, bones, brain, or kidneys.

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Tuberculosis Transmission

The spread of tuberculosis infection from one person to another through close contact, usually through the air.

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Tuberculosis Risk Factors

Circumstances that increase the likelihood of developing tuberculosis infection. These can include factors like living in crowded conditions, poverty, malnutrition, and having weakened immune systems.

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Mycobacterium tuberculosis

The bacterium that causes tuberculosis. Several strains exist, but the most common is Mycobacterium tuberculosis.

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Miliary Tuberculosis

A rare but serious form of tuberculosis that spreads rapidly through the bloodstream, often affecting young children.

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Post Primary Tuberculosis

A form of tuberculosis that occurs when the bacteria reactivates after a previous infection, often in the lungs.

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Pleural Tuberculosis

A rarer form of tuberculosis that affects the lining around the lungs, often causing chest pain and difficulty breathing.

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Abdominal Tuberculosis

Tuberculosis that affects the abdominal organs, often involving the lymph nodes, intestines, or peritoneum.

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Mesenteric Lymph Node Tuberculosis

A specific type of abdominal tuberculosis that mainly affects the lymph nodes in the abdomen, often mimicking other conditions.

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Peritoneal Tuberculosis

A form of abdominal tuberculosis that involves the lining of the abdominal cavity, often causing vague abdominal symptoms like pain and discomfort.

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Intestinal Tuberculosis

A form of abdominal tuberculosis that specifically affects the intestines, particularly the ileum and cecum, often mimicking other digestive diseases like Crohn's disease.

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Micronodules in the lungs

A sign of miliary tuberculosis where tiny nodules appear in the lungs, visible on chest X-ray.

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Cerebrospinal Fluid (CSF) Analysis

A medical test that can help diagnose tuberculosis by examining the cerebrospinal fluid, searching for signs of infection.

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Ganglionar Reaction

Inflammation of lymph nodes, particularly those near the hilum of the lung and along the trachea. This can occur as a result of tuberculosis infection.

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Hematogenous Dissemination

The spread of tuberculosis bacteria through the bloodstream. This can lead to widespread infection in various organs, including the brain, lungs, and bones.

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Meninges

The protective membranes that surround the brain and spinal cord. Tuberculosis infection can affect the meninges, leading to meningitis, a serious condition.

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Bones

Tuberculosis can infect bones, leading to bone lesions and abnormalities.

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Kidney

The kidneys can be affected by tuberculosis infection, leading to inflammation and dysfunction.

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Tuberculous Follicle

A small, localized area of inflammation containing infected macrophages, giant cells, and a central core of dead cells (caseum). This is a characteristic feature of tuberculosis infection.

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Primary Tuberculosis

The first exposure to tuberculosis bacteria. This can lead to latent infection, where the bacteria remain dormant, or active infection, which can cause symptoms.

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Latent Tuberculosis Infection

Tuberculosis infection that is present but without any symptoms. It is often discovered through testing, such as a tuberculin skin test.

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What are minor side effects of anti-TB drugs?

Minor side effects of anti-tuberculosis drugs that generally do not require treatment discontinuation. These effects often resolve with dose adjustments or supportive care.

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What are major side effects of anti-TB drugs?

Major side effects of anti-tuberculosis drugs that are serious and usually require immediate treatment discontinuation. These effects can be life-threatening and often necessitate further investigation.

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What is the role of Prednisolone in managing tuberculosis?

A corticosteroid medication used in certain tuberculosis cases, like severe lung involvement or meningeal inflammation, to reduce inflammation and improve patient outcomes. The use of this medication is generally for a limited period, starting with a full dose and progressively decreasing over time.

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What is the role of respiratory physiotherapy in tuberculosis management?

Physical therapy strategies used to improve breathing and lung function in patients with tuberculosis, especially those with lung collapse (atelectasis) or inflammation of the lining of the lungs (pleurisy).

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When is surgical intervention considered in tuberculosis?

Surgical intervention that may be required in some cases of tuberculosis, particularly when lymph nodes remain enlarged despite complete anti-tuberculosis treatment. This is generally considered as a last resort.

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Tuberculosis Medication Schedule

Medications for tuberculosis treatment are typically taken once daily in the morning on an empty stomach. This is the national recommended regimen.

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2RHZE Phase

An initial phase of tuberculosis treatment involving a combination of medications, typically Rifampicin (R), Isoniazide (H), Pyrazinamide (Z), and Ethambutol (E).

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2RH or 4RH Phase

A continuation phase of tuberculosis treatment, usually after the initial 2RHZE phase, where the number of medications is reduced.

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Treatment Regimen

A specific treatment approach used for tuberculosis that involves a combination of medications for an extended period. This varies depending on the type of tuberculosis.

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Mediastinal Lymphadenitis

A type of tuberculosis that affects the lymph nodes in the chest area. This can occur during a primary infection.

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Superficial Tuberculous Lymphadenitis

A rare form of tuberculosis affecting the skin and/or lymph nodes near the surface. This can cause swelling and tenderness.

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Tuberculous Pleural Effusion

A type of tuberculosis affecting the membranes surrounding the lungs, often causing fluid buildup.

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Multi-drug Resistant Tuberculosis

Tuberculosis that is resistant to multiple medications, making it difficult to treat.

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Tuberculous Meningitis

A type of tuberculosis that affects the membranes surrounding the brain and spinal cord. This form can be very serious.

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Study Notes

Introduction

  • Tuberculosis (TB) in children is a significant public health concern.
  • TB is a preventable and curable disease.
  • Diagnosis is challenging, relying on a combination of factors.
  • Prevalence is moderate in Algeria, with a focus on children under 15 years old, ranging from 7-10%.
  • Risk factors include family history, high-incidence areas, poverty, overcrowding, unsanitary conditions, and HIV infection.
  • Malnutrition is also a contributing factor.

Epidemiology

  • One-third of the global population is infected with Mycobacterium tuberculosis (TB).
  • Globally, 9.3 million new cases and 1.8 million deaths occur yearly.
  • There's declining prevalence in developed countries, but it remains a major concern.
  • TB is one of the most common infectious diseases in terms of morbidity and mortality, especially in context of HIV-positive status.

Pathophysiology

  • The main pathogen is Mycobacterium tuberculosis complex, primarily Mycobacterium tuberculosis.
  • Transmission is airborne through respiratory droplets.
  • Initial infection involves phagocytosis by alveolar macrophages, leading to potential immunity or progression.
  • Chronic infection can result in the formation of tubercles, possible spread via lymphatic and blood systems, and subsequent reactivation.
  • Different forms exist based on localization and severity.

Diagnostic

  • Latent infection can be detected via the Mantoux test.
  • Active disease can be diagnosed using a combination of clinical symptoms, radiological findings, and laboratory tests.
  • Differentiation between latent and active TB is crucial.
  • Accurate diagnosis requires careful evaluation of clinical presentation.
  • Particular attention is given to children, as presentations may differ from adults.

Treatment

  • First-line anti-TB drugs are used initially.
  • Treatment plans vary dependent on TB type and severity.
  • Adjuvant therapies may be necessary.
  • Adherence to the full treatment regimen is critical to avoid drug resistance.
  • Patient monitoring is essential for managing treatment side effects.

Prevention

  • Vaccination (BCG) is a crucial component of TB prevention.
  • Early detection and treatment of TB in community members are essential to reduce transmission.

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