「Tuberculosis in Children」の版間の差分

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2021年5月30日 (日) 16:56時点における版

epidemiology

  • 1.2 mil. (~10%) of 10 mil. new cases/year are under 15 y/o in 2019
  • third cause of deaths of children by infectious diseases

special issues in children TB

  • children TB means recent transmission
  • direct consequence of adult TB
  • difficulty of diagonsis
    • non-specific symptoms
    • difficulty to produce sputum
    • more likely to have paucibacillary lesions
      • means often negative sputum smear

risk factors

  • close contact with TB case
  • HIV co-infection
  • severe malnutrition
  • low socioeconomic level
  • promiscuity
  • enclosed space
  • low education for parents/care givers

latent TB

  • 80-90% of children cases
  • no symptoms
  • Mantoux test
    • IGRA is often unavailable in LMIC
  • R+H for 3 months

clinical TB

  • often paucibacillary, difficult to diagnose
    • false negative culture

pulmonary TB

  • 75% (60-80%) of clinical TB
  • <2 y/o symptoms are very uncommon
    • fever, weight loss, cough, anorexia, diarrhea
  • hilar adenopathy on CXR is very common
  • gastric aspiration when sputum unavailable

extrapulmonary TB

  • peripheral lymphadenitis TB counts for 50-60% of extrapulmonary TB in DRC
    • anterior cervical, submandibular, supraclavicular
    • painless, without inflammation, fistulation
  • TB pericardial effusion
    • rare but possible
    • right-side heart failure
  • bone/joint TB
    • large weightbearing bones/joints
      • Pott's diesase
      • cold abscess beside vertebra
      • gibbus deformity
  • abd TB
    • rare in children
  • TB meningitis
    • common in <2 y/o
    • BCG provides protection
    • no specific symptoms
      • fever, anorexia, weight loss,
    • 30% mortality
  • miliary TB
    • most common in <2 y/o
    • high fever, weight loss, respiratory distress,

treatment of clinical TB

  • H+R+Z+E
  • every morning 2 hours before eating
  • H 10 mg/kg/d
  • R 15 mg/kg/d
  • Z 25-30 mg/kg/d
  • E 20-25 mg/kg/d