Tuberculosis (TB) in Children

What are the common symptoms of TB in children?

The common symptoms of TB in children include coughing, fever, weight loss or failure to gain weight, night sweats, fatigue, chest pain, and difficulty breathing. However, these symptoms may not be specific to TB, and many children may experience no symptoms at all, making it difficult to diagnose the disease.

How is TB spread among children?

Source: American Thoracic Society. (2021). Tuberculosis. https://www.thoracic.org/patients/patient-resources/resources/tuberculosis.pdf

Can children catch TB from adults?

TB is spread among children through the airborne transmission of Mycobacterium tuberculosis (M.tb) bacteria. When someone with TB disease coughs or speaks, they release the bacteria into the air, and others can inhale them into their lungs. Children can also become infected by consuming unpasteurized milk or meat from an infected animal.

Why are children more susceptible to TB?

Source: World Health Organization. (2021). Tuberculosis. https://www.who.int/news-room/fact-sheets/detail/tuberculosis

What are the risk factors for TB in children?

Yes, children can catch TB from adults who are infectious. Children who live in high TB burden settings and have close and prolonged contact with adults with TB disease are at the highest risk of becoming infected.

What diagnostic tests are commonly used for TB in children?

The diagnostic tests commonly used for TB in children are tuberculin skin test (TST), interferon-gamma release assays (IGRAs), chest X-ray, sputum culture, and nucleic acid amplification tests (NAATs) such as GeneXpert. According to the World Health Organization (WHO), a combination of these tests is often used to diagnose TB in children. (Source: WHO. (2018). Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children.)

Can TB in children be detected through a physical exam?

While a physical exam can provide important information for the diagnosis of TB in children, it is not sufficient to make a conclusive diagnosis. Symptoms such as cough, fever, and weight loss may suggest TB, but they are not specific to the disease. Therefore, additional diagnostic tests such as TST, IGRA, chest X-ray, and sputum culture are necessary to confirm the diagnosis of TB in children. (Source: Starke, J. R. (2019). Diagnosis of tuberculosis in children.)

How reliable are TB skin tests for diagnosing TB in children?

TB skin tests, also known as Mantoux tests, have been used for many years to diagnose TB in children. However, their reliability is limited as they can produce false-positive results due to previous exposure to non-TB mycobacteria or the BCG vaccine. On the other hand, false-negative results can occur in children with weakened immune systems, who have recently been infected with TB, or who have received immunosuppressive therapy. Despite these limitations, TST remains an important diagnostic test for TB in children. It is often used in conjunction with other tests such as IGRA and chest X-ray to improve diagnostic accuracy. (Source: Mandalakas, A. M., & Hesseling, A. C. (2017). Clinical challenges and opportunities in the management of tuberculosis in human immunodeficiency virus-infected children.) 4. Chest X-ray is one of the most commonly used diagnostic tools for TB in children. It can show abnormalities in the lungs suggestive of TB such as infiltrates, cavities, or calcified nodules. However, chest X-ray is not specific for TB and can produce false-positive results due to other respiratory infections or non-infectious diseases. False-negative results can also occur in children with early-stage TB or extrapulmonary TB. Therefore, as with other diagnostic tests, chest X-ray should be interpreted in conjunction with clinical symptoms, microbiological tests, and other diagnostic tools. (Source: Cruz, A. T., Marais, B. J., & Starke, J. R. (2017). Tuberculosis in children.)

Is chest X-ray a reliable diagnostic tool for TB in children?

The criteria for a positive TB test in children depends on the type of test used. In general, a TST with an induration of 10 mm or greater is considered positive in children who are at low risk for TB such as those without known exposure. For children who are at high risk for TB such as those with close contact with TB patients or from TB-endemic areas, a TST with an induration of 5 mm or greater is considered positive. For IGRA, a positive result is defined by the manufacturer`s instructions and depends on the specific assay used. Any abnormality on chest X-ray suggestive of TB is considered a positive finding. However, a definitive diagnosis of TB requires confirmation by microbiological testing such as sputum culture or NAAT. (Source: Starke, J. R. (2019). Diagnosis of tuberculosis in children.)

What are the criteria for a positive TB test in children?

What are the most common antibiotics used to treat TB in children?

The most common antibiotics used to treat TB in children are isoniazid, rifampicin, pyrazinamide, and ethambutol. These medications are typically administered in combination for at least 6 months, in accordance with World Health Organization recommendations. Children with drug-resistant TB may require additional or alternative medications, which are determined based on drug susceptibility testing.

How long is the typical course of treatment for pediatric TB?

The typical course of treatment for pediatric TB is at least 6 months, and may be extended to up to 12 months for cases of more severe disease or drug-resistant TB. The duration of treatment may also be adjusted based on the child`s response to medication.

Is hospitalization necessary for children with TB?

Hospitalization is not always necessary for children with TB, but may be considered in cases where the child is very ill or requires close monitoring and support. Outpatient treatment is generally preferred for most cases of pediatric TB, as it allows the child to remain in a familiar environment and continue with daily activities.

Are there any alternative treatments for children who are resistant to standard TB medications?

In cases of drug-resistant TB, alternative medications may be prescribed based on the results of drug susceptibility testing. These medications may have more significant side effects or require longer treatment duration, and may be administered in combination with other medications. Alternative treatments such as surgery or immunotherapy may also be considered in rare cases.

What follow-up care is required after a child has completed TB treatment?

After completing TB treatment, children should be monitored closely for any signs of recurrence or medication side effects. Follow-up appointments may be scheduled to assess the child`s overall health and ensure that the TB infection has been successfully treated. In addition, children may be advised to undergo periodic chest x-rays to detect any residual or recurrent TB infections. Source: Centers for Disease Control and Prevention (CDC)

What is the prognosis for children with tuberculosis?

The prognosis for children with tuberculosis depends on various factors such as the severity of the disease, the child`s age, overall health status, and level of drug resistance, among others. According to the World Health Organization (WHO), the treatment success rate for pediatric TB cases is generally high, ranging from 90-95% in non-complicated cases. However, the prognosis can be worse for children with advanced TB or with underlying medical conditions.

How long does it take for children with TB to experience improvement in their condition after starting treatment?

It usually takes about two to four weeks for children with TB to experience improvement in their condition after starting treatment. However, the length of time varies depending on the severity and stage of the disease, as well as the child`s overall health condition.

Can children with TB fully recover and lead a normal life?

With early detection and appropriate treatment, children with TB can fully recover and lead a normal life. However, it is important that the child completes the full course of treatment to prevent the recurrence of the disease and the development of drug resistance. In addition, close monitoring and follow-up may be necessary to ensure that the child stays healthy.

Are there any long-term effects or complications associated with TB in children?

TB can have some long-term effects and complications in children if left untreated or if treatment is delayed. These can include damage to the lungs, spinal cord, or brain, as well as joint problems and hearing loss. Children with TB may also experience developmental delays and growth problems, especially if the disease affects multiple organs.

Does the prognosis for children with TB vary depending on the severity of the disease?

The prognosis for children with TB can vary depending on the severity of the disease. Children with mild or non-complicated TB tend to have a better prognosis and treatment success rate, while those with advanced or drug-resistant TB may require longer treatment and have a higher risk of treatment failure or relapse. Therefore, it is important to diagnose and treat TB in children as early as possible to improve their chances of a full recovery.