The document discusses tuberculosis (TB), highlighting its causes, epidemiology, pathology, and clinical features. It emphasizes the rising incidence of childhood TB due to factors like inadequate healthcare facilities and the HIV pandemic, as well as the complications and symptoms associated with various forms of TB. The document also details the impacts of TB on different age groups, particularly in children and adolescents, and outlines the seriousness of extrathoracic and central nervous system TB.

1. TUBERCULOSIS

2. CONTENTS
•INTRODUCTION
•EPIDEMIOLOGY
•HOST FACTORS
•PATHOLOGY
•CLINICAL FEATURES

3. INTRODUCTION
•TB IS CAUSED BY M. TUBERCULOSIS
MAGNITUDE
• GLOBALLY 10-12% OCCURS IN CHILDHOOD
• IN DEVELOPING COUNTRIES THE ANNUAL RISK OF INFECTION IN
CHILDREN IS 2-5%
• RATE OF INFECTION INCREASE BY 6 TIMES FOR AN HIV INFECTED
INDIVIDUAL

4. REASONS FOR AN INCREASE IN
CHILDHOOD TB
1. INADEQUATE FACILITY FOR DIAGNOSIS,PREVENTION AND
THERAPY
2. HIV PANDEMIC
3. EMERGENCE OF DRUG RESISTANCE

5. EPIDEMIOLOGY
• AGENT: HUMAN TYPE STRAIN OF M.TUBERCULOSIS
• MODE OF INFECTION-
1. INHALATION OF DROPLETS OF INFECTED SECRETION
2. RARELY TRANSPLACENTALLY,, SKIN AND MUCOUS
MEMBRANE
3. INFECTION THROUGH INJECTION OF INFECTED MATERIAL IS
RARE.

6. HOST FACTORS
• FREQUENCY OF INFECTION INCREASES WITH AGE
• ADOLESCENTS GIRLS MORE PRONE TO DEVELOP ACTIVE
TUBERCULOSIS
• DEPRESSED IMMUNE DEFENSE INCREASE SUSCEPTIBILITY.
• ILLNESS THAT AFFECT THE CMI INCREASE THE
SUSCEPTIBILITY

7. PATHOLOGY

8. HOST IMMUNITY IS
GOOD
HOST IMMUNITY IS
BAD

9. ● CAVITY FORMATION IS ASSOCIATED WITH LARGE
NUMBER OF TUBERCLE BACILLI.
● BACILLI SPREADS TO OTHER PARTS OF THE LOBE,
CAUSING LOBAR CONSOLIDATION.
● ENLARGED LYMPH NODES MAY COMPRESS THE
NEIGHBOURING AIRWAY.

10. ● ENLARGED PARA TRACHEAL LYMPH NODES MAY CAUSE
STRIDOR.
● ENLARGED SUBCARINAL NODES IMPINGE ON THE
ESOPHAGUS AND CAUSE DYSPHAGIA.
● IF OBSTRUCTION OF BRONCHI IS COMPLETE,
ATELECTASIS MAY OCCUR.

11. OUTCOME OF BRONCHIAL OBSTRUCTION
• COMPLETE EXPANSION AND RESOLUTION OF X-RAY FINDINGS
• DISAPPEARANCE OF SEGMENTAL LESIONS
• COMPRESSION OF LOBE LEADING TO BRONCHIECTASIS
❖TUBERCULOUS BRONCHITIS DUE TO CASEATED LYMPH NODE ERODING
THROUGH BRONCHUS
❖HEMATOGENOUS DISSEMINATION FROM INFECTED LYMPH NODES OCCUR
EARLY RESULTING IN A FOCI OF INFECTION
EG: SIMON FOCUS IN APEX OF LUNG

12. CLINICAL FEATURES
PPC
• MILD FEVER
• ANOREXIA
• WEIGHT LOSS
• IRRITATING DRY
COUGH
• THE INCUBATION PERIOD IS BETWEEN 4-8 WEEKS
PPD
● HIGH GRADE FEVER
● COUGH
● EXPECTORATION OF
SPUTUM
● HEMOPTYSIS
● ULCERATION OF BRONCHI

13. CHILDREN WITH ENDOBRONCHIAL TUBERCULOSIS USUALLY
PRESENTS WITH :
1. FEVER
2. COUGH(WITH OR WITHOUT EXPECTORATION)
3. DYSPNOEA
4. WHEEZE
5. CYANOSIS
6. EMPHYSEMA
7. COLLAPSE

14. EXTRATHORACIC TUBERCULOSIS
THE COMMON FORMS OF EXTRATHORACIC DISEASE IN CHILDREN INCLUDE
1. TB OF SUPERFICIAL LYMPH NODE
2. CNS
3. OSTEOARTICULAR
4. ABDOMINAL
5. GIT
6. GENITOURINARY
7. CUTANEOUS
8. CONGENITAL

15. TB OF SUPERFICIAL LYMPH NODE
• MAY BE ASSOCIATED WITH DRINKING OF UNPASTEURIZED COW MILK OR EXTENSION OF PRIMARY
LESIONS
• INVOLVES SUPRACLAVICULAR, ANTERIOR CLAVICULAR, TONSILLAR, SUBMANDIBULAR NODES
• LYMPH NODES MAY GET FIXED TO SURROUNDING TISSUE
• LOW GRADE FEVER IS THE ONLY SYSTEMIC SYMPTOM
• PRIMARY FOCUS VISIBLE RADIOLOGICALLY IN 30-70%
• TUBERCULIN TEST REACTIVE
• IF UNTREATED CAN PROGRESS TO CASEATING NECROSIS, CAPSULAR RUPTURE, SPREAD TO NODES AND
SKIN RESULTING IN DRAINING SINUS TRACT

16. CNS
• THE MOST SERIOUS COMPLICATION OF TB
• ARISES DUE TO CASEOUS LESION IN CEREBRAL CORTEX OR
MENINGES
• INFANTS -HYDROCEPHALUS, SEIZURES AND RAISED
INTRACRANIAL PRESSURE
• OLDER CHILDREN-FEVER, HEADACHE , IRRITABILITY,
DROWSINESS
• ADVANCES WITH LETHARGY, VOMITING NUCHAL RIGIDITY,
SEIZURE, HYPOTONIA ND FOCAL SIGNS
• FINAL-COMA, HYPERTENSION, DECEREBRATE AND DECORTICATE
POSTURING, DEATH

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