2. Background and Initial Presentation
15 year old Male
C/O Ongoing Cough for 3-4 weeks associated with significant Haemoptysis
Night sweats and increased Fatigue
Fever off and On for 3 weeks
Weight Loss
3. Past History
Dad had Tuberculosis when Child was 1 year old
Dad had a course of ATT ,Child had positive Mantoux , treated for exposure.
Had contact with Dad’s Cousin who was treated for TB spine 3-4 years ago .
Possible contact with other family member 4-5 years ago who had pulmonary
TB with Pleural Effusion .
4. He attended PAU 3 weeks ago with C/o Blood in sputum
Had an Nasophryngeal scopy done by the ENT.
Was treated as Haematasis and was given Omeprazole .
5. Examination
Looked ill, recent muscular mass loss.
No Significant cervical, Axillary , Supraclavicular Lymphadenopathy
No finger clubbing
Chest –clear , no conducted sounds
Abdomen and CNS examination – NAD .
6. Investigation
FBC – Hb 128 , WBC 11.2 , Plat 620 N , L 1.55 CRP 36 , ESR 82
PT 15.5 -17 , INR 1.3-1.5 , LFT , U+E NAD . T spot positive .
Chest Xray- B/l No obvious collapse , consolidation ,
CT Thorax - Cavitary lesions on right upper and middle lobe and left upper lobe
Tree in bud appearance
Sputum AFB positive .
8. Diagnosis Pulmonary TB in CHILDREN
Chronic Un remitting Cough for more than 3 weeks
Fever more than 38 C atleast 2 weeks other causes excluded.
Weight Loss and Failure to thrive
TB in children is often diagnosed clinically.
Paucibacillary, noncavitary pulmonary disease
9. Bacteriologic confirmation is achievable in less than 50 percent of children
and 75 percent of infants.
Recent close contact with an infectious case
A positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA)
Suggestive symptoms and findings on chest radiograph or physical
examination .
10. Tuberculin Skin Test
A positive TST may be present in both latent TB infection (LTBI) and in TB
disease.
False positive due to prior BCG vaccination
Infection with nontuberculous mycobacteria
improper administration or interpretation
TST positivity rates vary by form of disease and immunocompetence
Pulmonary and extrapulmonary TB, the TST is typically positive
Miliary TB and TB meningitis, the TST is usually positive in only 50%.
