Most children are sputum –ve and not infectious to others.
SOURCE OF INFECTION
Adult or family member with sputum smear positive.
Frequency of infection in a given population depends on:
(A) no: of infectious cases
(B) closeness of contact with an infectious
(C) age of child when exposed and the age
structure of the population
Extent of exposure to infectious droplet nuclei.
Infant whose mother has sputum smear positive PTB.
Chance of developing infection is greatest shortly after infection
Children under 5 yrs- less developed immune system.
Young age is a risk factor for sread of disease to other part of body,i.e. dissemination..
No specific features.
Failure to thrive
Weight loss( growth faltering)
Respiratory symptoms( cough> 3 weeks in child who received a course of broad spectrum anti- biotics.
Particularly difficult because they rarely cough up sputum.
Tuberculin skin test
Chest X ray.
A symptomatic child with a positive Mantoux test(>10mm) is to be treated as a case regardless of BCG vaccination in past
Dosages of anti-TB medication for children:-
DRUGS THERAPY PER DOSE (THRICE A WEEK) Isoniazid 10-15 mg/kg Rifampicin 10mg/kg Pyrazinamide 35mg/kg Streptomycin 15mg/kg Ethambutol 30mg/kg
For infant whose mother or any other houshold member is smear-positive,then
Chemoprophylaxis should be given for 3 months.
Then a mantoux test is done…
.If test is negative-stop chemoprophylaxis
and BCG is given
.If test is positive,chemoprophylaxis is
continued for a total duration of 6 months..
Guidelines IF AND THEN child has symptoms of TB An MO determines (preferably in consultation with a paediatrician) that the child has TB…. A full course of anti TB treatment (CAT3) should be given… The child does not have symptoms of TB. . A tuberculin test is not available . .A tuberculin test is available Chemoprophylaxis for 6 months (Isoniazide daily-5mg/kg) The child should receive 3 months of INH chemoprophylaxis IF IF THEN The induration is less than 6mm in diameter Stop chemoprophylaxis and give BCG . The induration is 6mm or more in diameter Continued INH chemoprophylaxis for another 3 months
TUBERCULOSIS & HIV
To make global situation worse,
tuberculosis has formed lethal partnership
Co-infection of tb &hiv has increased the risk of activation of infection from
10% over the lifespan to 10%per year.
worldwide approximately 1/3 rd of all AIDS related deaths are associated with TB.
HIV infection infection increases the risk of developing active TB by a factor of 100.
Levels of plasma HIV RNA increase in setting of active TB and decline in setting of successful l TB treatment.
Reactivation of latent infection:
25-30% more likely to develop the disease than the people only with TB.
In the community
Depend on the count of the CD4 cells.
Pulmonary reactivation disseminated disease diffuse or lower