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Tuberculosis in Children

بسم الله الرحمن الرحيم. Tuberculosis in Children. Dr. Satti A/Rahim Satti. Most of the cases occur in developing countries . More than one third of the worlds` population is infected. Etiology. The disease is caused by a bacteria called “ Mycobacterium tuberculosis ” ! Gram +ve.

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Tuberculosis in Children

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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 .

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  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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