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Characteristics of tuberculosis in children


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Characteristics of tuberculosis in children

  1. 1. People’s Friendship University of Russia Characteristics of tuberculosis in childhood Ghodiwala Tossif Ml-610 Moscow 2013
  2. 2. • In early childhood tuberculosis has the greatest tendency to progression, and that leads to the development of the most severe forms of tuberculosis. • Child deaths from tuberculosis predominantly observed at this age, most often in the first year of life. • The epidemiological situation of tuberculosis in young children characterized by low infectivity relatively high morbidity and high mortality rate.
  3. 3. • Infant – generalized form of TB • Preschool and school age – less generalized and more particular to lymphatic system • Adolescence- infiltrative and disseminated form
  4. 4. Anatomical and physiological characteristics INFANTS • Immature immunity • Slow immune response • URT -short and wide unlike. LRT -longer and narrow • Relatively dry mucousa (insufficient number of mucous glands) • Poor elasticity of acini • Insufficient surfactant • Not well developed pleura • Cough reflex not fully developed
  5. 5. Anatomical and physiological characteristics Adolescent period • Metabolic changes • Neuro-endocrine imbalance • Increase in the functional needs of the organism • Psychological changes – Bad habits – Diet – Social status
  6. 6. Tuberculosis in different age categories has certain features, which consequently contributes to the formation of various degrees of residual changes after the disease.
  7. 7. TB by the Numbers • One-third of the world’s population has TB. • 9 million people are infected each year. • Roughly 1.5 million people die each year from the complications of TB. • 8.5 million children have been orphaned due to TB. • 22 countries account for 80% of TB cases worldwide.
  8. 8. Incidence
  9. 9. Percent of US Pediatric TB Cases by Age Group 1993–2006 N=15,946 Age 10-14 18.2% Age 5-9 23.1% Age < 1 9.2% Age 1-4 49.5% CDC data
  10. 10. Distribution
  11. 11. High-risk Factors for Childhood TB • Poverty- Poor children often live in overcrowded conditions and lack access to healthcare. • Young Age-Because of their weak immune systems, infants under one year of age have a 40 percent chance of contracting TB if they do not receive preventive therapy when exposed to an adult with infectious TB.
  12. 12. • Malnutrition - Weak immune systems and malnutrition go hand in hand and make children more susceptible to active TB. • HIV- TB is the third leading killer of children with AIDS and kids with HIV are up to 20 times more likely to develop TB than healthy children. • Maternal TB - Children often contract TB from their mothers or other primary caregivers who have TB.
  13. 13. Transitions in Childhood Tuberculosis Contact with smear positive index case Not infected (50-70%) Infected (30-50%) Diseased (10-30%) Within 2 years (50%) Lifelong (50%)
  14. 14. • Risk of progression to disease is increased when primary infection occurs particularly in the very young (0–4 years). • Children who develop disease usually do so within 2 years following exposure and infection, i.e. they develop primary TB. • A small proportion of children (generally older children) develop post-primary TB either due to: – – Reactivation, after a latent period, of dormant bacilli acquired from a primary infection or By reinfection.
  15. 15. Age at primary infection Risk of disease following primary infection. < 1year No disease Pulmonary disease (segmental) TBM or miliary 50% 20-40% 10-20% 1-2 years No disease Pulmonary disease (segmental) TBM or miliary 70% 10-20% 5-10% 2-5 years No disease Pulmonary disease (segmental) TBM or miliary 95% 5% 0. 5% 5-10 years No disease Pulmonary disease (segmental, effusion or adult type) TBM or miliary 98% 2% <0. 5% > 10 years No disease Pulmonary disease (adult type) TBM or miliary 80% 10-20% <0. 5%
  16. 16. “These kids are the reservoir for adult TB,” Dr. David Manissero
  17. 17. Which factors influence children to become infected? Mostly “Environmental” • Exposure - Never exposed = never infected - Duration of exposure • Bacterial load • Close contact with infected
  18. 18. Only Adults Transmit TB Adult Number of bacilli in sputum Child 108 104 Need about 105 organisms/ml for positive smear
  19. 19. What are the chances of a child under the age of 12 being able to transmit TB? •Only a fraction of 1%
  20. 20. But why? • Paucibacillary disease (fewer organisms) • Cannot cough/spread infection as well
  21. 21. • In adults, the most common way to diagnose TB is to look at mucus coughed up (sputum) and test it for the TB germ through sputum cultures. • Most children, however, have a dry cough and do not produce sputum. In the rare instance that the child does produce sputum.
  22. 22. Difficult to diagnose • paucibacillary, rarely culture confirmed : • Sputum smear positive in 10.3% (10-14yr), 1.8% (5-9) and1.6% (<5) • Cultures positive 21% (10-14), 5% (5-9) and 4.2% (<5), • Extrapulmonary TB
  23. 23. Severity • TB in children is more severe than adults. • Infants have a particularly high morbidity and mortality from TB. • It is likely that the high rate of progressive TB seen in young children is largely a reflection on the immaturity of the immune response.
  24. 24. Every day, more than 200 children under the age of 15 die needlessly from TB – a disease that is preventable and curable.