1. Tuberculosis in Children
بسم الله الرحمن الرحيم
Tuberculosis in Children
Dr. Satti A/Rahim Satti

2. Most of the cases occur in developing countries .
More than one third of the worlds` population is infected.
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3. Etiology
The disease is caused by a bacteria called “Mycobacterium tuberculosis”
! Gram +ve.
! Acid-fast.
! Grow slowly.
! Resist decoloration with ethanol.
“Mycobacterium bovis” also contribute to infection .
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4. Mycobacterium
tuberculosis
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5. Epidemiology Majority get only subclinical infection .
So “Latent tuberculosis infection” LTBI.
Clinically the child will get :
# Pulmonary tuberculosis .
# Extrapulmonary tuberculosis.
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6. Transmission From person to person.
Through inhalation by airborne mucus droplet nuclei.
Rarely by direct contact : discharge or fomite .
M. bovis : by airborne or through ingestion .
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7. Pathogenesis
Get what is called “Primary complex” that include : Local infection (primary lesion ) + regional lymph nodes .
The primary lesion may heal completely or progress .
Formation of granuloma & caseous material .
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8. Possible exposure to an adult with or at high risk for infectious pulmonary TB is the most crucial risk factor for children.
Tubercle bacilli are carried to most tissues of the body through the blood & lymphatic vessels from the primary complex .
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9. Clinical Manifestations
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10. Primary Pulmonary TB Get the primary pulmonary complex.
Hilar lymphadenopathy, focal hyper- inflation & then atelectasis.
Extensive infiltrate, collapse or consolid- ation .
Caseous nodes erode through, causing endobronchial TB or a fistula tract.
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12. Bronchiectasis is a complication.
Symptoms include : Nonproductive cough, dyspnea, fever, night sweats & ↓ activity .
Pulmonary signs are : Localized wheezing, ↓ breath sounds, tachypnea or respiratory distress.
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13. May get “ Progressive primary pulmonary TB ”
# Formation of a primary cavity.
# Further intrapulmonary dissemination .
# Signs include : dullness, rales & ↓ breath sounds.
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14. Pleural effusion is a complication. ! Local or general.
! Usually unilateral.
! Fever & chest pain.
! The fluid is yellow, contain a large no. of WBC & glucose is low.
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15. Disseminated Tuberculosis
Called Lymphohematogenous TB.
Spiking fever, hepatomegaly, splenomeg- aly, lymphadenitis & skin tuberculids.
Meningitis occurs late.
Can present as Miliary disease.
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16. In miliary TB lesions are in lungs,spleen, liver & bone marrow.
Later lungs will be filled with tubercles causing dyspnea, cough & crepts.
Get choroid tubercles.
Pneumothorax may develop.
CXR : Miliary shadow.
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17. ,
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18. Lymph node TB Get TB of superficial lymph nodes, called Scrofula .
In the past was usually caused by drinking unpasteurized milk laden with M. bovis.
Lymph nodes in the neck, inguinal, axillary or epitrochlear are affected.
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19. L. nodes are firm, discrete, nontender & fixed to tissues.
Low grade fever.
L. nodes are firm, discrete, nontender & fixed to tissues.
Later get a mass of matted nodes.
Caseation, necrosis & draining sinus tract.
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20. ,
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21. TB of Central Nervous System
The most serious complication in children.
1) Tuberculous meningitis :
! Clinically get 3 stages.
! 1st: nonspecific symptoms.
! 2nd: signs of meningitis & ↑ intra cranial pressure .
! 3rd: coma, hemiplegia, decerebrate posturing & eventually death.
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22. ! Dysfunction of cranial nerves lll , Vl & Vll .
! May develop Seizures.
! Dysfunction of cranial nerves lll , Vl & Vll .
! Communicating hydrocephalus.
! Permanent disabilities : blindness, deafness, paraplegia, diabetes insipidus or mental retardation.
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23. ! Presents as a brain tumor. ! Most often singular, may be multiple .
2) Tuberculoma :
! Presents as a brain tumor.
! Most often singular, may be multiple .
! Headache, fever & convulsions.
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24. Bone & joint TB Pott`s disease # Tuberculous spondylitis.
# Gibbus deformity.
# Kyphosis .
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25. .
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26. Abdominal & Gastrointestinal TB
Tuberculous peritonitis
$ Generalized or localized peritonitis.
$ Lymph nodes, omentum & peritonium rarely become matted & can be palpated as a ` doughy ` irregular, non-tender mass.
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27. Tuberculous enteritis.
Tuberculous enteritis
$ There is abdominal pain, diarrhea or constipation, weight loss & fever.
$ Mesenteric adenitis usually complicates the infection.
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28. Diagnosis
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29. .
Exposure history to an adult with or at high risk for infectious pulmonary TB (Young children with TB rarely infect other children or adults )
Early morning gastric contents or sputum is sent for acid-fast bacilli (AFB) or culture.
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30. Tuberculin skin testing : ! Called Mantoux test.
! ID injection of 0.1 ml (5 tuberculin units of purified protein derivative (PPD) .
! False-negative.
! False-positive.
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31. .
Heigh ESR level.
PCR (a rapid test).
Radiology (X-rays).
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33. Clinical criteria for diagnosis of TB are : Fever . Cough .
Weight loss.
History of contact.
Positive mantoux.
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34. The Treatment
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35. Anti-tuberculous Drugs
Isoniazid “ INH ”
! Given orally or intramuscularly.
! Daily dose is mg/Kg.
Rifampin “ RIF ”
! Oral & IV forms.
! In form of capsules.
! The dose is mg/Kg daily.
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36. . Pyrazinamide “ PZA ” ! The dose is 30 mg/Kg daily.
! May lead to hyperuricemia & gout.
Streptomycin “ STM ”
! Given IM or IV.
! The dose is mg/Kg daily.
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37. ! The dose is 15-25 mg/Kg daily. ! Orally once or twice a day.
Ethambutol “ EMB ”
! The dose is mg/Kg daily.
! Orally once or twice a day.
Ethionamide “ ETH ”
! For drug-resistant TB.
! The dose is mg/Kg daily.
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38. .
Other Drugs :
@ Kanamycin & Amikacin In a dose of mg/Kg daily by inj.
@ Cycloserine In a dose of mg/Kg daily.
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39. . Corticosteroids : & Prednisone 1-2 mg/Kg/day for 4-6 wks.
& In cases of tuberculous meningitis, with pleural effusion & in severe miliary TB.
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40. Supportive care : # Report all cases .
# Adequate nutrition is important .
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41. Treatment regimens Several drugs are used together.
The standard therapy is 4 drugs for the 1st 2 mo. Then 2 drugs for the next 4 mo.
Bone, joint, disseminated & CNS TB are treated for 9-12 mo.
DOT : Directly observed therapy.
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42. Drug-resistant TB There are 2 major types of drug resistance :
1. Primary resistance.
2. Secondary resistance.
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43. Prevention Case finding and its treatment .
Testing of high-risk groups .
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44. BCG vaccination : # Named Bacille Calmette-Gue´rin.
# It is live attenuated .
# A single dose given intradermaly at birth .
# Local ulceration &
regional adenitis
are side effects.
# Contraindicated in
1ry or 2ndry imm-
unodeficiencies.
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45. ]\
Thank You All
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