Clinical Evaluation of Tuberculosis in Children
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GaddafiClinical Evaluation of Tuberculosis in Children
Uploaded by
GaddafiSession 3: Clinical Evaluation
of Tuberculosis in Children
Overview of Clinical Evaluation of Tuberculosis in
Children
In this session you will learn about:
1. Key consideration in clinical evaluation of TB in children
2. Recommended approach to diagnose TB in children
3. Contact screening and investigation
4. Symptoms screening
5. Physical examination of a child with symptoms of TB
6. Atypical clinical presentation of childhood TB in children
Session Learning Outcomes
By the end of this session you will be able to;
1. Describe key considerations in the clinical evaluation of childhood TB
2. Outline the recommended approach to clinical evaluation of children for
Tuberculosis
3. Determine atypical presentation of childhood pulmonary tuberculosis
Diagnosis of TB in Children Image
Key Considerations
• The diagnosis of TB can be made with confidence in the
majority of children using careful clinical assessment
• It may be difficult to confirm diagnosis of TB in many children
but it is usually not so difficult to make a clinical diagnosis of TB
in a child
• Even though microbiological diagnosis is not always feasible, all
efforts should be made to get a specimen for bacteriological
confirmation of TB.
• A trial treatment with anti-TB drugs is NOT RECOMMENDED
as a method of diagnosing TB in children.
Recommended Approach to Diagnose TB in
Children
1. Careful history
• History of TB contact is key
• Symptoms suggestive of TB
2. Physical examination
• TB can affect any part of the body apart from the hair, nails and teeth
• Includes growth assessment
3. Tuberculin skin test
4. Bacteriological confirmation whenever possible
5. Investigations relevant for suspected PTB or suspected EPTB
6. HIV testing
History of Contact
History of contact with an adolescent or adult with proven or suspected TB
• Close contact is defined as living in the same household as or in frequent
contact with smear positive PTB index case; the primary care giver
(remember the nanny)
• Ask about anyone in the household/dormitory/classroom/school transport with
chronic cough. If present request assessment of that person for possible TB
• Most children will develop TB within one year of exposure
Symptoms Screening
The commonest symptoms associated with TB include:
• Progressive and non-remitting cough
• Fever
• Lethargy /reduced playfulness
• Weight loss, no weight gain or poor weight gain (failure to thrive)
• Specific signs and symptoms depending on the site of extra-pulmonary TB
Physical Examination
• TB can affect any part of the body apart from the hair, nails and teeth; features
are specific to the affected system
• Examination of the respiratory system may reveal features of a respiratory
infection
• In some cases, there may be atypical clinical presentations of PTB
• A normal respiratory clinical finding does not rule out PTB
Atypical Clinical Presentations of Childhood PTB
Acute severe pneumonia
• Presents with respiratory distress and crackles
• Occurs especially in infants and HIV-infected children
• Suspect PTB if response to antibiotic therapy is poor. If child is HIV infected also
suspect other HIV-related lung disease e.g. PCP
Wheeze
• Asymmetrical and persistent wheeze can be caused by airway compression due to
enlarged tuberculous hilar lymph nodes
• Suspect PTB when wheeze is asymmetrical, persistent and non-responsive
to bronchodilator therapy
The End
You have come to the end of session 3, kindly proceed to session 4 on investigations
for diagnosis of childhood TB.
Asante
