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Understanding Tuberculosis in Children: Causes, Symptoms, and Treatment Options

Tuberculosis (TB) remains a significant health challenge in developing countries, affecting one-third of the global population. It is primarily caused by the bacterium Mycobacterium tuberculosis, leading to diverse clinical manifestations, including pulmonary and extrapulmonary TB. The transmission occurs via airborne droplets, necessitating awareness of risk factors for early diagnosis. Symptoms may include cough, fever, and weight loss, highlighting the need for timely intervention. Effective treatment involves anti-tuberculous drugs, emphasizing the importance of recognizing TB signs in children for better health outcomes.

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Understanding Tuberculosis in Children: Causes, Symptoms, and Treatment Options

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  1. بسم الله الرحمن الرحيم Tuberculosis in Children Dr. Satti A/Rahim Satti

  2. Most of the cases occur in developing countries . • More than one third of the worlds` population is infected.

  3. Etiology • The disease is caused by a bacteria called “Mycobacterium tuberculosis” ! Gram +ve. ! Acid-fast. ! Grow slowly. ! Resist decoloration with ethanol. • “Mycobacterium bovis” also contribute to infection .

  4. Mycobacterium tuberculosis

  5. Epidemiology • Majority get only subclinical infection . • So “Latent tuberculosis infection” LTBI. • Clinically the child will get : # Pulmonary tuberculosis . # Extrapulmonary tuberculosis.

  6. Transmission • From person to person. • Through inhalation by airborne mucus droplet nuclei. • Rarely by direct contact : discharge or fomite . • M. bovis : by airborne or through ingestion .

  7. Pathogenesis • Get what is called “Primary complex” that include : Local infection (primary lesion ) + regional lymph nodes . • The primary lesion may heal completely or progress . • Formation of granuloma & caseous material .

  8. Possible exposure to an adult with or at high risk for infectious pulmonary TB is the most crucial risk factor for children. • Tubercle bacilli are carried to most tissues of the body through the blood & lymphatic vessels from the primary complex .

  9. Clinical Manifestations

  10. Primary Pulmonary TB • Get the primary pulmonary complex. • Hilar lymphadenopathy, focal hyper- inflation & then atelectasis. • Extensive infiltrate, collapse or consolid- ation . • Caseous nodes erode through, causing endobronchial TB or a fistula tract.

  11. Bronchiectasis is a complication. • Symptoms include : Nonproductive cough, dyspnea, fever, night sweats & ↓ activity . • Pulmonary signs are : Localized wheezing, ↓ breath sounds, tachypnea or respiratory distress.

  12. May get “ Progressive primary pulmonaryTB ” # Formation of a primary cavity. # Further intrapulmonary dissemination . # Signs include : dullness, rales & ↓ breath sounds.

  13. Pleural effusion is a complication. ! Local or general. ! Usually unilateral. ! Fever & chest pain. ! The fluid is yellow, contain a large no. of WBC & glucose is low.

  14. Disseminated Tuberculosis • Called Lymphohematogenous TB. • Spiking fever, hepatomegaly, splenomeg- aly, lymphadenitis & skin tuberculids. • Meningitis occurs late. • Can present as Miliary disease.

  15. In miliary TB lesions are in lungs,spleen, liver & bone marrow. • Later lungs will be filled with tubercles causing dyspnea, cough & crepts. • Get choroid tubercles. • Pneumothorax may develop. • CXR : Miliary shadow.

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  17. Lymph node TB • Get TB of superficial lymph nodes, called Scrofula . • In the past was usually caused by drinking unpasteurized milk laden with M. bovis. • Lymph nodes in the neck, inguinal, axillary or epitrochlear are affected.

  18. Low grade fever. • L. nodes are firm, discrete, nontender & fixed to tissues. • Later get a mass of matted nodes. • Caseation, necrosis & draining sinus tract.

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  20. TB of Central Nervous System The most serious complication in children. 1) Tuberculous meningitis : ! Clinically get 3 stages. ! 1st: nonspecific symptoms. ! 2nd: signs of meningitis & ↑ intra- cranial pressure . ! 3rd: coma, hemiplegia, decerebrate posturing & eventually death.

  21. ! May develop Seizures. ! Dysfunction of cranial nerves lll , Vl & Vll . ! Communicating hydrocephalus. ! Permanent disabilities : blindness, deafness, paraplegia, diabetes insipidus or mental retardation.

  22. 2) Tuberculoma : ! Presents as a brain tumor. ! Most often singular, may be multiple . ! Headache, fever & convulsions.

  23. Bone & joint TB Pott`s disease # Tuberculous spondylitis. # Gibbus deformity. # Kyphosis .

  24. .

  25. Abdominal & Gastrointestinal TB Tuberculous peritonitis $ Generalized or localized peritonitis. $ Lymph nodes, omentum & peritonium rarely become matted & can be palpated as a ` doughy ` irregular, non-tender mass.

  26. . Tuberculous enteritis $ There is abdominal pain, diarrhea or constipation, weight loss & fever. $ Mesenteric adenitis usually complicates the infection.

  27. Diagnosis

  28. . • Exposure history to an adult with or at high risk for infectious pulmonary TB. (Young children with TB rarely infect other children or adults ) • Early morning gastric contents or sputum is sent for acid-fast bacilli (AFB) or culture.

  29. Tuberculin skin testing : ! Called Mantoux test. ! ID injection of 0.1 ml (5 tuberculin units of purified protein derivative (PPD) . ! False-negative. ! False-positive.

  30. . • Heigh ESR level. • PCR (a rapid test). • Radiology (X-rays).

  31. Clinical criteria for diagnosis of TB are : • Fever . • Cough . • Weight loss. • History of contact. • Positive mantoux.

  32. The Treatment

  33. Anti-tuberculous Drugs • Isoniazid “ INH ” ! Given orally or intramuscularly. ! Daily dose is 10-15 mg/Kg. • Rifampin “ RIF ” ! Oral & IV forms. ! In form of capsules. ! The dose is 10-20 mg/Kg daily.

  34. . • Pyrazinamide “ PZA ” ! The dose is 30 mg/Kg daily. ! May lead to hyperuricemia & gout. • Streptomycin “ STM ” ! Given IM or IV. ! The dose is 20-40 mg/Kg daily.

  35. Ethambutol “ EMB ” ! The dose is 15-25 mg/Kg daily. ! Orally once or twice a day. • Ethionamide “ ETH ” ! For drug-resistant TB. ! The dose is 15-20 mg/Kg daily.

  36. . • Other Drugs : @Kanamycin & Amikacin In a dose of 15-30 mg/Kg daily by inj. @Cycloserine In a dose of 10- 20 mg/Kg daily.

  37. . • Corticosteroids : & Prednisone 1-2 mg/Kg/day for 4-6 wks. & In cases of tuberculous meningitis, with pleural effusion & in severe miliary TB.

  38. Supportive care : # Report all cases . # Adequate nutrition is important .

  39. Treatment regimens • Several drugs are used together. • The standard therapy is 4 drugs for the 1st 2 mo. Then 2 drugs for the next 4 mo. • Bone, joint, disseminated & CNS TB are treated for 9-12 mo. • DOT : Directly observed therapy.

  40. Drug-resistant TB • There are 2 major types of drug resistance : 1. Primary resistance. 2. Secondary resistance.

  41. Prevention • Case finding and its treatment . • Testing of high-risk groups .

  42. BCG vaccination : # Named Bacille Calmette-Gue´rin. # It is live attenuated . # A single dose given intradermaly at birth . # Local ulceration & regional adenitis are side effects. # Contraindicated in 1ry or 2ndry imm- unodeficiencies.

  43. ]\ Thank You All

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