Paediatric Tuberculosis (Infectious Diseases)
Learning Outcomes
a. Define Tuberculosis (TB) and its mode of transmission
b. Outline the difference between Latent TB and TB Disease
c. Describe the clinical presentation of TB in children.
d. Outline a structured approach to the diagnosis of TB in
children
e. Initiate and monitor treatment according to the National
guidelines
Introduction
Tuberculosis (TB) is a disease caused by an organism
called Mycobacterium tuberculosis. It belongs to a
genetically related group of species called The
Mycrobacterium tuberculosis complex (MTC or MTBC)
which can cause tuberculosis in humans or other animals.
*M. tuberculosis The members of the complex
include: M. africanum, M.
M. bovis bovis , M. canettii , M.
The M. caprae , M. microti , M.
tuberculosis M. africanum mungi , M. orygis, M.
complex:
pinnipedii, M. suricattae , and M.
M. microti tuberculosis.
M. canetti.
Figure 1: The M. tuberculosis complex causes TB in humans
TB primarily affects the lungs and it is called Pulmonary TB
(PTB). However, TB can also affect other organs of the
body such as the bones, lymph nodes, heart, abdomen
and the brain. This is called Extra-Pulmonary TB.
TB remains a major cause of mortality in people living with
HIV. An estimated 33 percent of deaths among children
living with HIV are due to TB. It is estimated that TB
affects about 1.1 million children and adolescents under
the age of 15 annually with Africa contributing about 28%
of the TB case burden and 50% of TB deaths to the global
figures.
Mode of transmission
TB is spread through inhalation of tiny, infected droplets
which contain TB bacilli when a person with TB coughs,
sneezes, talks or sings. Mycobacterium bovis is
transmitted through consumption of unpasteurised milk
products.
Latent TB Vs TB Disease
Latent TB infection
When a child is exposed to
the TB bacilli, he or she
may become infected with
TB. This is called TB
infection. If the child does
not exhibit any signs and
symptoms of TB, it is called
latent TB.
Fig.2: After exposure to TB a child can either
have Latent TB or develop TB disease
TB Disease
If a child infected with TB is symptomatic, this is referred to as
TB disease and may be infectious.
Differences between Latent TB and TB Disease
Table 1: Differences between Latent TB and TB disease
Type of TB Latent TB TB Disease
Symptoms No symptoms Symptomatic
Infectivity Can not spread to others May spread to
others
Treatment May consider treatment Needs treatment
to prevent progression to
TB disease
TST/IGRA Positive Usually, positive
Smear/GeneXpert Negative Positive or
negative
Imaging None/calcified Abnormal
granulomas radiological
findings.
Clinical Presentation of TB in Children
The clinical spectrum of TB in children is usually wider and
non-specific compared to adults. The most common
clinical presentation of PTB is persistent respiratory
symptoms and poor weight gain. Children usually under 5
years present with atypical clinical signs and symptoms. In
extrapulmonary TB Symptoms vary by site but generally
include persistent fever, weight loss/poor weight gain and
fatigue or reduced playfulness.
Structured approach to Diagnosis of Childhood TB
• A detailed history should be taken and documented in
the patient’s file. This should be followed by a thorough
physical examination.
• Consolidate history, physical examination and
laboratory and/or radiological findings.
• Collection of age-appropriate samples
• Use of urine LAM were indicated
Figure 3: Systematic evaluation of childhood TB
Initiation and monitoring of TB treatment
TB treatment in children and adolescents includes a 2-
month intensive phase followed by a continuation phase of
either 2, 4 or 10 months. Duration of treatment is
dependant on the type and severity of the TB disease
(Table 2). The drugs used in the treatment of TB include
isoniazid (H), rifampicin (R), pyrazinamide (Z) and
ethambutol (E). Corticosteroids are indicated in the
management of some complicated forms of TB, such as:
TB meningitis, Complications of airway obstruction by TB
lymph glands and Pericardial TB.
Table 2: Recommended regimens for treatment of drug
susceptible TB in children and adolescents
Follow up of children on TB treatment includes monitoring
response to the treatment and observing for and treating
side effects of the ATT.
2.7. Summary
TB in children is a global and national burden. Clinical
presentation of TB in children includes fever, cough, poor
weight gain, reduced playfulness and maybe nonspecific.
The clinical presentation of TB in children maybe with
typical or atypical symptoms. Although diagnosis of TB in
children is challenging, following a structured approach
makes it easier to make the diagnosis. Drugs used in the
management of TB in children includes isoniazid (H),
rifampicin (R), pyrazinamide (Z) and ethambutol (E).
Exercises / Learning activities
1. What is tuberculosis?
2. How is tuberculosis diagnosed?
3. What is the clinical presentation of PTB?
4. List the different types of EPTB and their clinical
presentations?
5. List the drugs used in treatment of TB and list down
the most common side effects of each drug.
6. Apart from corticosteroids, what other drugs are
given during TB treatment?
References/Resources
• National Tuberculosis and leprosy consolidated
programmed consolidated tuberculosis guidelines.
Ministry of Health; 2022.
• WHO consolidated guidelines on tuberculosis. Module 5:
management of tuberculosis in children and
adolescents. Geneva: World Health Organization; 2022.
Licence: CC BY-NC-SA 3.0 IGO.
