Pediatric tuberculosis

1,891 views
1,678 views

Published on

Published in: Health & Medicine, Technology
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,891
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
103
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Pediatric tuberculosis

  1. 1. Pediatric Tuberculosis
  2. 2. Tuberculosis 411  Caused by mycobacterium tuberculosis  Can cause latent TB or primary TB  Primary TB can be pulmonary or extrapulmonary TB  Spread by aerosolized particles during coughing, sneezing, or speaking  Children less likely to spread  Extrapulmonary TB is not transmitted  Incubation period is 2-12 weeks  Time from infection to identification of a primary lesion on TST
  3. 3. Worldwide TB Epidemiology  8.7 million NEW cases per year  490,000 pediatric cases  Low burden countries – 5% pediatric cases  High burden countries- 20% pediatric cases  Infants and young children are more prone to develop life threatening forms   Disseminated TB TB meningitis  1.4 million deaths  64,000 pediatric deaths  Top ten cause of pediatric death
  4. 4. Worldwide
  5. 5. US Incidence
  6. 6. Clinical Features  Bimodal presentation  Children < 5 y/o and adolescents >10 y/o  Most children asymptomatic  Most common symptoms:         Chronic cough (>21 days) +/- wheezing Dyspnea Hemoptysis Fever (>14 days) Weight loss/FTT Weakness/lethargy Night sweats
  7. 7. Pulmonary TB  Pulmonary parenchymal disease and intrathoracic adenopathy  Most common: 60-80% of cases
  8. 8. Extrapulmonary TB  Harder to diagnose  Symptoms highly suggestive of extrapulmonary TB  Gibbus from vertebral body  Enlarged or painless joints  Cervical lymphadenopathy with fistula  Meningitis or pleural effusion not responsive to antibiotics  Pericardial effusion  Abdominal ascites
  9. 9. TB meningitis  CNS involvement is common  Symptoms include:  Headache  Neck stiffness  Coma  Hemiplegia  Seizures  LP to diagnose  SIADH is common
  10. 10. Latent TB  Do not show any symptoms of the disease  Not infectious  Can transition from LTBI to active TB more frequently and faster (within weeks)  Conversion rate is 5% in 2 years
  11. 11. Diagnosis  Must distinguish between latent TB (LTBI) or TB  Diagnostic tests include  TST/QFT-GIT  CXR  AFB/Sputum culture  Majority of case ( < 12y/o) are paucibacillary  Microscopically negative for AFB  Culture negative  Smear positive TB only 20-40% of pediatric cases
  12. 12. Diagnosis  TST- Mantoux method: 0.1ml dermal injection of PPD into volar surface of forearm   Positive can mean current or future active TB False positive in BCG vaccine and non tuberculosis mycobacteria  Interferon-gamma release assays (IGRAs)  IGRAs can not distinguish between current or past  QuantiFERON-TB Gold in Tube (QFT- GIT) ELISA test QFT- GIT and TST sensitivity: 38% and 35%  QFT- GIT and TST specificity: 81% and 84%   Nucleic acid amplification tests (NAATs)  Used in neg. AFB microscopy and to detect drug resistance
  13. 13. TST Guidelines
  14. 14. Laboratory tests  TST- Mantoux method: 0.1ml dermal injection into volar surface of forearm   Positive can mean current or future active TB False positive in BCG vaccine and non tuberculosis mycobacteria  Interferon-gamma release assays (IGRAs)  IGRAs can not distinguish between current or past  QuantiFERON-TB Gold in Tube (QFT- GIT) ELISA test QFT- GIT and TST sensitivity: 38% and 35%  QFT- GIT and TST specificity: 81% and 84%   Nucleic acid amplification tests (NAATs)  Used in neg. AFB microscopy and to detect drug resistance
  15. 15. Pulmonary TB on CXR  Primary TB- infiltrate usually in middle or lower lobe  Ipsilateral hilar adenopathy  Any lobe can be affected  25% multilobar  Endogenous TB- develops from LTBI  Infiltrate in upper lobes  Cavitation and collapse  Both can have atelectasis, pleural effusions, pericardial effusion, or lymphadenopathy
  16. 16. Primary TB Treatment  Initial phase for 2 months then continuation phase for 4 months  Isoniazid (INH) and rifampicin (RIF)  Bactericidal, decrease microbial loads  RIF and pyrazinamide (PZA)  Sterilizing drugs that eradicate slow- replicating organism  Ethambutol (EMB)   Protects against the emergence of drug resistant TB Not used in <8 y/o’s due to concerns for optic neuritis  Disseminated TB and TB meningitis treatment is 12 months  LTBI treatment:  INH daily for 6-9 months or RIF for 4 months

×