Tuberculosis causes a major burden on health and economics of low income countries. The delay in diagnosis and inability to cure a high proportion of pulmonary smear positive adult TB cases are the main reasons of increased risk of infection and consequent high mortality in children.
It is important for pediatricians, physicians and related health workers to identify TB in children and manage it accordingly.
What is TB ?
TB is an infectious, systemic, chronic granulomatous disease caused by Mycobacterium tuberculosis. It is an aerobic, non spore forming acid fast bacilli.
Mode Of Infection
Infection occurs almost exclusively through the respiratory system by inhalation of tubercle bacilli. TB spreads from the primary lung lesion to other parts of the body via blood stream and lymphatics or by direct extension. Majority of children acquire the disease by being exposed to adults with pulmonary infectious TB.
- TB may be asymptomatic in as many as 50% of children.
- Children may present with non specific signs and with minimal or no respiratory symptoms.
- Cough, fever,anorexia, weight loss, sweating, respiratory distress, lymph adenopathy, wheezing, decreased breath sounds and rales may be seen.
- A child may have concurrent extra pulmonary involvement as well.
Extra Pulmonary TB
Extra pulmonary TB is defined as those children with AFB smear or culture positive specimen from an extra pulmonary site or a patient with histological and or clinical evidence consistent with active extra-pulmonary TB. In 25% of children with disease TB affects other organs, such as lymph nodes (most common), central nervous system, intestines, pleura, pericardium, bones and joints, genito urinary tract and other parts of the body. Diagnosis is often difficult and should preferably be made by physicians. Extra pulmonary Tb is usually non-infectious.
It is considered as the most serious complication of TB in children because of high mortality and morbidity. It is the most common form of extra pulmonary TB after TB lymphadenitis. It most commonly occurs in children below 5 years of age. . Diagnosis is suspected on clinical grounds and then confirmed on lumbar puncture where CSF shows lymphocytic pleocytosis, high protein and low glucose.