Tuberculosis in Children
Section snippets
Epidemiology of childhood tuberculosis
The knowledge of the global epidemiology of TB in children is somewhat limited. In 1990, approximately 7,500,000 TB cases occurred worldwide, of which 650,000 occurred in children [1]. In 2002, the WHO estimated that 8,800,000 TB cases occurred worldwide, based on data from 209 countries with an estimated mean case rate of 145 per 100,000 population (range, 2–1067 cases) [2]. Although estimates, these numbers can be particularly useful when assessing the effectiveness of TB control programs.
Risk factors for latent tuberculosis infection and progression to tuberculosis disease
Several recent studies have assessed the risk factors for LTBI among children in the United States. Risk factors varied somewhat from study to study but generally included close contact with a TB case, birth in a country with high prevalence of TB, travel to or a household visitor from a high-prevalence country, a family member with LTBI, contact with a high-risk adult (eg, an adult who is infected with HIV/AIDS, homeless, incarcerated, or a user of illicit drug) and age greater than 11 years
Pathogenesis
The pathogenesis of pediatric TB is largely similar to that described for adults and older adolescents, but subtle differences in pathogenesis can lead to differences in clinical presentations. As in adults, more than 98% of infections in children occur when M. tuberculosis bacilli enter the lungs through aerosolized droplets expelled when an infectious adult coughs, sneezes, or sings [6]. Other less common portals of entry include the gastrointestinal tract, the skin, mucous membranes, and
Latent tuberculosis infection
In both adults and children, LTBI is defined as infection with M. tuberculosis as evidenced by a positive TST and lack of clinical or radiographic signs or symptoms of TB disease. Radiographs are usually normal but may show evidence of healed primary complex in the form of dense nodules (with or without calcifications), calcified nonenlarged regional lymph nodes, or pleural thickening [16], [17]. CT scans are generally not indicated in children with LTBI unless a chest radiograph is equivocal.
Diagnosis of pediatric latent tuberculosis infection and tuberculosis
The diagnosis of TB infection or disease rests on the basic components of history (eg, previous TB or contact with infectious case, signs, and symptoms), TST results including the precise millimeters of induration, chest or other radiographic findings, and mycobacteriology smear and culture results. LTBI is relatively simple to diagnose in children. Criteria for diagnosis are
A positive TST as interpreted based on stratification of risk factors (Box 1)
Normal chest radiograph or radiographic
Treatment of latent tuberculosis infection and tuberculosis disease
Children with LTBI and TB are treated with the drugs used for adults, although regimens, side-effect profiles, and availability of antituberculous drugs in pediatric doses may differ. Further, recommendations for pediatric regimens and doses from national and international organizations (eg, the British Thoracic Society, American Thoracic Society, WHO) may differ. Nevertheless, the backbone of all recommended regimens for LTBI is isoniazid unless the child has been exposed to an
Public health aspects of pediatric tuberculosis
As with adults, the public health sector plays an important role in control of TB in children through a hierarchy of activities that range from identification and treatment of patients with TB disease to conducting public health investigations of infectious source cases and identifying and treating patients with LTBI [19]. Following recognition of an infectious adult or adolescent case, a contact investigation is performed to identify exposed persons, including children and adolescents, and
Summary
The epidemiology of pediatric TB continues to be shaped by risk factors such as age, race, immigration, poverty, overcrowding, and HIV/AIDS. Once infected, young children have an increased risk of TB disease and progression to extrapulmonary disease because of immunologic host factors. The pathogenesis of disease differs from that in adults, because primary disease and its complications are more common in children. This prevalence of primary disease in turn leads to differences in clinical and
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Cited by (56)
Formulation and Bioequivalence Testing of Fixed-Dose Combination Orally Disintegrating Tablets for the Treatment of Tuberculosis in the Paediatric Population
2020, Journal of Pharmaceutical SciencesCitation Excerpt :Clinical manifestation of TB depends on the site of infection. Pulmonary TB, historically referred to as consumption or pthisis, classically manifests as severe wasting,8 as well as cough, haemoptysis, chest pain, dyspnoea, malaise, fatigue, low-level fever and night sweats.9 Extrapulmonary TB can include the same symptoms as pulmonary TB, with a wide range of additional symptoms based upon the site of infection, such as meningitis (CNS), lymphadenitis (lymphatic), arthritis (skeletal) and haematuria (renal).10
Pediatric Anesthesia in Developing Countries
2019, A Practice of Anesthesia for Infants and ChildrenPediatric Anesthesia in Developing Countries
2018, A Practice of Anesthesia for Infants and ChildrenTuberculosis in HIV-infected infants, children, and adolescents in Latin America
2015, Brazilian Journal of Infectious DiseasesCitation Excerpt :The diagnosis of TB is further complicated in HIV-infected children2 presenting with advanced immune-suppression when Pneumocystis jiroveci, disseminated bacterial, fungal and viral infections, or other mycobacterial agents mimic or coexist with TB disease, and treatment is started empirically for more than one etiological agent in severely ill patients.3 Interpretation of tuberculin skin tests is difficult, with false negative results occurring in HIV-infected children who are immunocompromised and false positive results occurring in Latin-American regions with moderate to high endemicity like Brazil, where BCG is routinely given at birth.4,5 Many investigators have reported on pediatric HIV-TB co-infection in Africa,6–9 but few such studies have been conducted in Latin America.10–12
Diagnosis of tuberculosis in paediatrics
2010, Anales de Pediatria