TB is a chronic infectious disease caused in most cases by Mycobacterium tuberculosis. Occasionally it can be caused by Mycobacterium bovis or Mycobacterium africanum
Diagnosis of TB in children is difficult because of the presence of a wide range of non-specific symptoms. It is important to make a clear distinction between infection and disease: in infection, only the Mantoux test may be positive (>10mm), but the child is healthy and does not have any signs and does not, therefore, need anti TB treatment. If there is TB-disease there are clear signs and symptoms.
Symptoms and signs may be confusing in children co-infected with HIV. Diagnosis rests largely on the results of clinical history, a history of TB contact in the family, clinical examination, x-ray examination and tuberculin testing.
In most cases, sputum cannot be obtained and if obtained may be negative because the bacterial load is generally low. Attempts should always be made, however, to obtain a sputum sample for direct smear microscopy. Early morning gastric aspirates may yield AFBs and can be carried out if spontaneous sputum cannot be obtained.
Children should be strongly suspected of having TB when they are contacts of a known adult case of pulmonary TB and have clinical signs and symptoms (recent weight loss or failure to gain weight and/or cough or wheezing > 2 weeks).
In the absence of confirmation, the diagnosis of active TB can be made and treatment commenced when any one of the following conditions is met:
• Radiological picture of miliary pattern.
• Pathologic findings compatible with TB from a biopsy or surgically removed lesion.
Doubtful cases who are suspected of having TB but who do not meet the criteria for the diagnosis should be seen after 6-8 weeks for re-evaluation.
I. Table 1. Criteria for the diagnosis of tuberculosis in children
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SUSPECTED TUBERCULOSIS
An ill child with a history of contact with a confirmed case of pulmonary tuberculosis
Any child:
• Not regaining normal health after measles or whooping cough
• With loss of weight, cough and wheeze not responding to antibiotic therapy for respiratory disease
• With painless swelling of superficial lymph nodes
PROBABLE TUBERCULOSIS
A suspect case and any of the following:
• Positive (10 mm in diameter) induration on tuberculin testing (see appendix V)
• Suggestive appearance on chest radiograph (e.g. unilateral hilar/mediastinal lymphnode enlargement with or without lobar or segmental opacity, miliary patter, pleural effusion, infiltrates and cavitations)
• Suggestive histological appearance of biopsy material
CONFIRMED TUBERCULOSIS
• Detection by microscopy or culture of tubercle bacilli from secretions or tissues
• Identification of tubercle bacilli as Mycobacterium, tuberculosis by culture
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Treatment
Short course chemotherapy as Category III
The treatment regimen for this category is 2(RHZ)/6EH
This regimen consists of 8 weeks treatment with Rifampicin, Isoniazid and Pyrazinamide during the intensive phase followed by six months ethambutol and Isoniazid
