This document provides an overview of pediatric tuberculosis. It discusses that M. tuberculosis is the main causative agent and can spread through airborne droplets. Children under 5 years old are most vulnerable. The presentation of TB in children varies and can include pulmonary or extrapulmonary disease. Diagnosis involves clinical features, tuberculin skin testing, radiology, and microbiological methods like smear microscopy and culture. Treatment consists of a standard 6 month drug regimen. Monitoring includes checking for clinical response and side effects. BCG vaccination is recommended for infants.

1. PEDIATRIC
TUBERCULOSIS
DR.V.ANU REKHA
ASSISTANT PROFESSOR

2. INTRODUCTION
 Causative agent- Mycobacterium tuberculosis
 Less common- Mycobacterium bovis, M. Avium
intra cellulare
 Acid fast bacilli, non motile
 Obligate aerobe
 Discovered by Dr. Robert Koch, 1882
 White plague of 18 th century

3.  Mode of infection- droplet spread, air borne
infection
 Primary site of infection- lung
 May remain dormant- latentTB infection
(LTBI)
 May get activated – disease
 Affects almost all organs of the body

4. HOST FACTORS
 Age: no exemption for any age. Infants >>
more vulnerable
 Sex: adolescent girls; around puberty
 Malnutrition: undernourished >> more
susceptible; depressed immunological
reaction. SAM child who doesn’t respond to
nutritional therapy should be evaluated for
TB

5.  Immunodeficiency: both primary and
secondary- HIV, DM, immuno suppressives
 Inter-current infections: post viral
Incubation period: 4 to 8 weeks

6. How prevalent is TB in
children?
 In India, 3.42 lakh children getTB every year
 Male= female
 31% global burden
 6 % of cases reported to NTEP
 PulmonaryTB most common
 Extra pulmonary is common compared to adult

7. PATHOGENESIS

8. Primary complex (Ghon`s
complex)

11. EXTRA PULMONARY TB
 Lymph nodeTB
 Pleural effusion
 Meningitis
 DisseminatedTB
 Renal
 Bone
 GenitourinaryTB

12. CLINICAL FEATURES
 Primary infection:
 Asymptomatic
 Mild fever, anorexia, weight loss, decreased
activity
 Cough – inconsistent
 Diagnosed incidentally
 LatentTB(LTBI)- no symptoms/disease ;but
shows only hypersensitivity toTB;

13.  Progressive primary complex:
 High grade fever, cough- consolidation
 Endo-bronchial:
 troublesome cough, dyspnea, wheezing
 Miliary:
 Hematogenous spread ; infants
 Innumerable small foci
 Acute onset, high grade fever

14.  Pleural effusion:
 Rupture of sub-pleural focus
 Occurs due to the hypersensitivity to
tubercular proteins
 > 5years of age
 Insidious onset fever, cough , dyspnea,
pleuritic chest pain (pleural rub) initially

15.  Lymphadenitis:
 Extension of the primary
lesions of the lung
 mainly cervical nodes;
painless, matted
 Advances to caseating
necrosis (cold abscess),
rupture, draining sinus

16.  CNS tuberculosis:
 Rich focus in the brain- lympho hematogenous
spread
 Infants and children <4 years- vulnerable
 Infants- rapid progression- hydrocephalus, raised
ICT, seizures
 Older child- sub acute course
 Headache, irritability, drowsiness, vomiting,
focal signs

17.  AbdominalTB:
 Hematogenous spread
 Non specific abdominal pain
 Doughy abdomen- omental involvement
 Rolled up omentum , mesenteric adenitis,
thickened ileum- irregular nodular mass
 Ascites
 Hepato splenomegaly

18. DIAGNOSIS
 Clinical signs and symptoms
 CXR
 Tuberculin skin testing
 History of contact
 Microbiological confirmation- gold standard
Contact :
 Any child who lives in a household with an
adult taking ATT or has taken in the past 2
years.

19. COLLECTION OF SPECIMEN
 Gastric aspirate:
 In children who cant expectorate
 Early morning- after 4 to 6 hours fasting
 Pooled sample of swallowed sputum
 Induced sputum:
 Salbutamol nebulisation – hypertonic saline
nebulisation- nasopharyngeal aspirate with
suction
 Expectorated sputum

20.  Bronchio-alveolar lavage fluid
 FNAC of lymph node
 Biopsy of the node
 CSF
 Pleural fluid
 Ascitic fluid

21. MICROBIOLOGICAL DIAGNOSIS
 Ziehl –Neelson technique
 Auramine Rhodamine staining
 Cartridge based Nucleic acid amplification
technique (CB-NAAT)- 2 hours; identifies
rifampicin (rif) sensitivity
 Tru- NAT- 45 minutes

22. Culture:
 Lowenstein Jensen medium- conventional-
6weeks
 Mycobacterial growth indicator tube(MGIT)-
liquid culture- 2 weeks
 Line probe assay (LPA)- for detecting the drug
sensitivity
 Interferon gamma release assay(IGRA)-
alternative to Mantoux
 CopenhagenTB (CTb ) test- yet to come

23. MANTOUX TEST
 Demonstrate delayed type hypersensitivity
 2TU of tuberculin PPDRT23 0r 5TU of PPD-S
 0.1 ml of PPD ; intradermal; volar aspect of
forearm
 Read after 48-72 hours
 Induration (not erythema) to be measured
 > 10 mm & >5 – in immuno compromised
significant
 False positive- Atypical mycobacteria infection
 False negative- immuno compromised

24. RADIOLOGICAL DIAGNOSIS
CHEST X RAY:
 Highly suggestive:
 Hilar or para tracheal lymph adenopathy
 Miliary
 Cavitary
 Non specific shadows
 Broncho pneumonia, consolidation, collapse,
emphysematous change ,pleural effusion etc

25. DIAGNOSTIC ALGORITHM
PRESUMPTIVETB DIAGNOSIS
 Persistent fever >2wk, without a known cause
and/or
 Unremitting cough for >2wk and/or
 Weight loss of 5%; or, no weight gain in past 3
mo despite adequate nutrition; or, failure of
nutritional rehabilitation in babies with
severe acute malnutrition
 With or without contact with patient with
pulmonaryTB in past 2 years

27. DIAGNOSTIC ALGORITHM FOR DRTB

29. NATIONAL TB ELIMINATION 2025

30. TREATMENT

31.  Only 1 category (4HRZE+ 2HRE); No class 2
 Total duration- 6 months; daily
 Neurological, bone, joint- continuation phase
extended up to 10 months
 Fixed dose combinations(FDC)
 Second line drugs: Quinolones, Injectable
aminoglycosides
 Newer- Bedaquiline; Delamanid

32. WEIGHT BANDS

33. MONITORING OF THERAPY
 Every 2-4 weeks initially; then every 4 -8 weeks
 Clinical resolution: maximum of 6 to 8 weeks
 Check for compliance
 Look for anthropometry, side effects of drugs
 If no response- think of DRTB
 Radiological- after 2weeks or based on clinical
response; clearance occurs late
 Microbiological- not routinely

34.  Notifiable disease
 Registered through NIKSHAY

35. NEONATES OF MOTHER WITH TB
CongenitalTB
 Hematogenous spread through umblical
vessels – primary foci- liver
 Ingestion of infected amniotic fluid- lung
 Post natal transmission possible
 Rule out active infection in neonate

36.  Mother can breast feed (if she had completed
1 month of intensive phase)
 Cough etiquette to be followed
 BCG can be given immediately
 Isoniazid prophylaxis ( INH 10 mg/kg/day
along with pyridoxine ) for 6 months
 Closely watch the baby for the development
of disease

37. ISONIAZID PREVENTIVE THERAPY
 Children < 5 years with Contact with adult
 Children 5 to 15 years who have tested for
LTBI
 Children with HIV
 Children on immunodeficiency or on
immunosuppressive drugs
 INH should be given 10 mg/kg/day for 6
months along with pyridoxine after ruling out
active disease

38. BACILLUS CALMITTE GUERIN (BCG)
VACCINE
 0.1 ml ; intra dermal; left arm; at the insertion
of deltoid
 Live attenuated vaccine
 Given at birth; Can be given up to 1 year
 Prevents serious extra pulmonary form ofTB
 Not for primary complex
 Efficacy- 20-80%
 Complication : BCG abscess, BCG adenitis,

40. THANK YOU