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DEPARTMENT OF PEDIATRICS
COLLEGE OF MEDICINE
CAGAYAN STATE UNIVERSITY
OUTLINE
• Review
• TB in children
• Diagnosis
• Treatment
• Prevention
Risk for TB infection and disease
The diagnosis of childhood tuberculosis in low/intermediate burden settings Dr. Anne Detjen Desmond Tutu TB
Centre, Cape Town and
Dr. Klaus Magdorf Charite University Hospital, Berlin
TUBERCULOSIS
Pulmonary TB
• Latent TB infection (LTBI)
Extra-pulmonary TB
• TB adenitis
• CNS TB
• TB of bones and joints
• GITB
• Cutaneous TB, scrofuloderma, erythema nodosum
• Ocular TB
• GU TB
Manifestation can be predicted:
• Pulmonary: months after primary infectionS
• Miliary, TB Meningitis, Diss TB: 26mos
• TB adenitis: 3-9 mos
• Bones & joints: 1 year
• Renal: 5-25 yrs
WALLGREN’S TIMETABLE OF TB IN CHILDREN
CLINICAL FORM TB
TB EXPOSURE – a condition in which child is in
close contact with contagious adult or adolescent TB
cases, but without any signs and symptoms of TB ,
with negative TST reaction, and no radiologic and
laboratory findings suggestive of TB
• EPTB
Classification of TB Disease
• New case
• Retreatment
Epidemiological
- exposure to an adult/ adolescent with active TB
disease
Clinical
- signs and symptoms suggestive of TB
Immunological
- positive Tuberculin Test
Radiologic
- abnormal chest radiograph suggestive of TB
Laboratory
- laboratory findings suggestive of TB ( histological,
cytological, biochemical, immunological and/or
molecular
Symptomatic child
Organ-specific symptoms
(EPTB)
Exposure to a TB case
Principle: T-cells of
individuals with TB
infection secrete IFN-
γ in response to re-
stimulation with M.
tb-specific antigens
Policy recommendation: IGRAs
Overall conclusions
Insufficient data and low quality evidence on the
performance of IGRAs in low- and middle-income
countries, typically those with a high TB and/or HIV
burden
IGRAs and the TST cannot accurately predict the risk of
infected individuals developing active TB disease
Neither IGRAs nor the TST should be used for the
diagnosis of active TB disease
IGRAs are more costly and technically complex to do than
the TST.
Given comparable performance but increased cost,
replacing the TST by IGRAs as a public health intervention
in resource-constrained settings is not recommended.
Chest Radiography and other investigations
PTB – CXR
The commonest picture: persistent opacification in
the lung together with enlarged hilar or subcarinal
lymph glands.
A miliary pattern of opacification children is highly
suggestive of TB.
Adolescents:
large pleural effusions and apical infiltrates with cavity formation
being the most common forms of presentation (similar to
adults).
may also develop primary disease with hilar adenopathy and
collapse lesions visible on CXR.
IDENTIFY PRESUMPTIVE TB CASES
Pyrazinamide (Z) C:30 (20-40) mkD (max Disruption of membrane Most common cause of
2g/day) energy metabolism hepatotoxicity in
A: 25 (20-30)mkD regimens containg H
and R
Corticosteroids
– most beneficial when host inflammation
reaction contributes significantly to tissue damage or
impairment of organ functions
- benefits od corticosteroids has been evaluated
in the following forms of complicated TB
* TB Meningitis
* TB pericarditis
* TB Pleural effusion
* Endobronchial TB
* Miliary TB
Summary