4. DEFINITION
Tuberculosis is a chronic infectious disease caused by a bacteria
called mycobacterium tuberculosis.
Mycobacterium tuberculosis can infect the lungs causing
pulmonary tuberculosis and other organs such as, the spine,
kidneys, brain, the CNS, the lymph nodes, GI tract etc. causing
extra pulmonary tuberculosis.
A child can be infected with TB bacteria and not have active
disease.
5. STAGES OF TB IN A CHILD
Exposed stage: this is when a child has been in contact with a person who
has TB, but the child still has negative TB skin or blood test, a normal chest
x-ray, and no symptoms.
Latent TB infection: this is when a child has TB bacteria in their body, but
does not have symptoms. The infected child’s immune system causes the
TB bacteria to be inactive. For most people who are infected, the TB will
be latent for life. This child will have a positive TB skin or blood test but a
normal chest x-ray and no TB symptoms. They cant spread the infection to
others.
6. STAGES OF TB IN A CHILD
TB disease: this is when a child has signs and symptoms of an
active infection. This child will have a positive or negative TB
skin or blood test, and test showing active TB disease in the
lungs or other sites in the body. They can spread the disease if
the infection is in the lungs and it is untreated.
7. RISK FACTORS
Living with someone who has TB
HIV infection
Extreme of ages especially children less than 5 years old.
Severe malnutrition
Immunosuppression
8. PATHOPHYSIOLOGY
Inhalation of air borne mucus droplet nuclei 1-5 micron
in diameter.
10 -200 droplets can cause TB infection.
Droplet nuclei can stay in air for up to 72 hours in dark, damp room
[sunlight kills them].
When a person inhales droplet nuclei containing TB bacilli, they reach
the alveoli of the lungs.
9. PATHOPHYSIOLOGY
These bacilli are ingested by alveoli macrophages, the majority of these bacilli
are destroyed or inhibited. A small number may multiply and are released when
the macrophages die.
These bacilli may spread to other parts of the lungs and through the lymphatic
channels or through the bloodstream to distant tissues and organs example;
pleural cavity, lymph nodes, kidneys, brain and bones.
The bacilli which goes in to the lungs causes pulmonary TB and the bacilli that
spreads to other parts of the body causes extra pulmonary TB [visceral TB,
bone and joint TB, cutaneous TB, CNS TB, perinatal TB].
10. CLINICAL PRESENTATION
The presentation of TB in children differs from adults and also varies
within pediatric age groups [infants, toddlers, children, and adolescents]
as follows.
• Infants and children less than age 5 are more likely to develop TB once
infected than children five to ten years old.
Cough [2 weeks]
Fever[2weeks]
Night sweets
12. DIAGNOSIS
Clinical diagnosis
A good history from the patient or mother and physical examination.
chest x-ray
A lateral and posterior-anterior view to assess for pulmonary TB.
Microscopy
• Specimen collection culture
Sputum, gastric aspiration, lumber puncture can be used to culture.
Gene xpert
13. MANAGEMENT
recommended treatment regimens for new cases of TB
TB Diagnostic Category Anti-TB drug regimen
Intensive phase Continuation
phase
Low HIV prevalence [and HIV- negative children and low isoniazid resistance settings
Smear-negative pulmonary TB
Intrathoracic lymph node TB
Tuberculosis peripheral lymphadinitis
2HRZ 4HR
Extensive pulmonary disease
Smear-positive pulmonary TB
Severe forms of extrapulmonary TB [other than tuberculosis
meningitisosteoarticular TB].
2HRZE 4HR
High HIV prevalence or high isoniazid resistance or both
Smear-positive PTB
Smear-negative PTB with ir without extensive parenchymal disease
All forms of EPTB except tuberculosis meningitis and osteoarticulat TB
2HRZE 4HR
Tuberculosis meningitis and osteoarticular TB in all regions 2HRZE 10HR
14. TREATMENT CONT….
Doses of Anti-TB Drugs
As children approach a body weight of 25kg, adult dosages can be used
Drugs Suggested daily dose
Isoniazid 10[7-15] mgkg
Rifampicin 15[10-20] mgkg
Pyrazinamide 35[30-40] mgkg
Ethambutol 20[15-25] mgkg
