Tuberculosis in Children

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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