MD1TALK
TB in children 🌟
Risk factors for TB:
• Poverty and crowding ,immunosuppression, recent infection in last 2 y.
Epidemiology:
Children <5 years progresses rapidly from latent infection to
disease, with severe form as: miliary TB and meningitis.
Most children are infected by household contacts, Even
when adult cases are sputum smear negative.
Adolescent infection:
Most adolescents present with clinical symptoms.
Rates of extrathoracic TB is high especially with TB meningitis.
Most cases were acid-fast bacilli (AFB) sputum smear negative.
Clinical manifestations:
I) Pulmonary tuberculosis:
Its Pulmonary disease + intra-thoracic adenopathy.
• Common symptoms of pulmonary TB:
1) Chronic cough that is not improving for > 3 weeks.
2) Fever > 38°C for at least 2 weeks.
3) Weight loss or failure to thrive (FTT).
• These symptoms are nonspecific ( can come with other lung
diseases) → only factor in differentiating between them →
history of contact with an infectious TB and a positive
tuberculin skin test (TST).
Physical examination:
1)Presence of lower respiratory tract infection signs
(but not specific).
2)Children ages 5 -10 years may present with clinically silent
disease (but radiographically apparent).
3)Infants more likely to present with signs and symptoms of
lung disease.
II)Extra-pulmonary tuberculosis:
In children, the most common site is: TB of superficial lymph
nodes and CNS.
Neonates have the highest risk of progression to
miliary TB and meningitis.
Other forms of TB:
, MD1TALK
• Tuberculous meningitis: meningitis not responding
to Abx antibiotics, with a subacute onset,
hydrocephalus, stroke, and elevated intra-cranial pressure (ICP).
• Pleural TB: causing Pleural effusion.
• Pericardial TB: causing Pericardial effusion.
• Abdominal TB:causing Distended abdomen with ascites,
abdominal pain, jaundice, or unexplained chronic diarrhea.
• TB adenitis: painless, fixed, enlarged lymph nodes, Kyphos (or
Gibbus):
especially in the cervical region. Is a sharp
• TB of the joint: Non tender joint effusion. posterior
angulation.
• Vertebral TB: Back pain, gibbus deformity, especially of This may be a
result of
recent onset. congenital
• Skin Warty lesion: papulonecrotic lesions, lupus vulgaris; defect, a
fracture, or
erythema nodosum. spinal
tuberculosis.
• Renal: Sterile pyuria, hematuria.
• Perinatal TB: can be life-threatening infection with ↑
mortality.
1)Congenital TB:
- Caused by: tuberculous endometritis or disseminated TB in
mother.
- Route: hematogenously via placenta or by aspiration of
amniotic fluid.
- Manifestations: respiratory distress, fever, poor feeding,
lethargy, Low birth weight, and hepatosplenomegaly.
2)Neonatal TB :
Following exposure to mother's aerosolized secretions.
IF you suspected congenital TB: do tuberculin skin test (TST), chest
x-ray (CXR), lumbar puncture, cultures (blood and respiratory specimens),
and placenta acid-fast bacilli (AFB) staining and culture, HIV testing.
Tuberculin skin test (TST) in newborns is usually negative, but an
interferon-gamma release assay (IGRA) test may be positive.
Post-exposure to TB:
Baseline test: All should be offered HIV testing if HIV status is unknown.
Symptomatic: sputum smear microscopy + CXR
Asymptomatic:
• Children < 5y and/or HIV positive: TST or IGRA + chest x-ray
• Everyone else: TST or IGRA
TB in children 🌟
Risk factors for TB:
• Poverty and crowding ,immunosuppression, recent infection in last 2 y.
Epidemiology:
Children <5 years progresses rapidly from latent infection to
disease, with severe form as: miliary TB and meningitis.
Most children are infected by household contacts, Even
when adult cases are sputum smear negative.
Adolescent infection:
Most adolescents present with clinical symptoms.
Rates of extrathoracic TB is high especially with TB meningitis.
Most cases were acid-fast bacilli (AFB) sputum smear negative.
Clinical manifestations:
I) Pulmonary tuberculosis:
Its Pulmonary disease + intra-thoracic adenopathy.
• Common symptoms of pulmonary TB:
1) Chronic cough that is not improving for > 3 weeks.
2) Fever > 38°C for at least 2 weeks.
3) Weight loss or failure to thrive (FTT).
• These symptoms are nonspecific ( can come with other lung
diseases) → only factor in differentiating between them →
history of contact with an infectious TB and a positive
tuberculin skin test (TST).
Physical examination:
1)Presence of lower respiratory tract infection signs
(but not specific).
2)Children ages 5 -10 years may present with clinically silent
disease (but radiographically apparent).
3)Infants more likely to present with signs and symptoms of
lung disease.
II)Extra-pulmonary tuberculosis:
In children, the most common site is: TB of superficial lymph
nodes and CNS.
Neonates have the highest risk of progression to
miliary TB and meningitis.
Other forms of TB:
, MD1TALK
• Tuberculous meningitis: meningitis not responding
to Abx antibiotics, with a subacute onset,
hydrocephalus, stroke, and elevated intra-cranial pressure (ICP).
• Pleural TB: causing Pleural effusion.
• Pericardial TB: causing Pericardial effusion.
• Abdominal TB:causing Distended abdomen with ascites,
abdominal pain, jaundice, or unexplained chronic diarrhea.
• TB adenitis: painless, fixed, enlarged lymph nodes, Kyphos (or
Gibbus):
especially in the cervical region. Is a sharp
• TB of the joint: Non tender joint effusion. posterior
angulation.
• Vertebral TB: Back pain, gibbus deformity, especially of This may be a
result of
recent onset. congenital
• Skin Warty lesion: papulonecrotic lesions, lupus vulgaris; defect, a
fracture, or
erythema nodosum. spinal
tuberculosis.
• Renal: Sterile pyuria, hematuria.
• Perinatal TB: can be life-threatening infection with ↑
mortality.
1)Congenital TB:
- Caused by: tuberculous endometritis or disseminated TB in
mother.
- Route: hematogenously via placenta or by aspiration of
amniotic fluid.
- Manifestations: respiratory distress, fever, poor feeding,
lethargy, Low birth weight, and hepatosplenomegaly.
2)Neonatal TB :
Following exposure to mother's aerosolized secretions.
IF you suspected congenital TB: do tuberculin skin test (TST), chest
x-ray (CXR), lumbar puncture, cultures (blood and respiratory specimens),
and placenta acid-fast bacilli (AFB) staining and culture, HIV testing.
Tuberculin skin test (TST) in newborns is usually negative, but an
interferon-gamma release assay (IGRA) test may be positive.
Post-exposure to TB:
Baseline test: All should be offered HIV testing if HIV status is unknown.
Symptomatic: sputum smear microscopy + CXR
Asymptomatic:
• Children < 5y and/or HIV positive: TST or IGRA + chest x-ray
• Everyone else: TST or IGRA
