8.2 TB In Children

Question 1

TB is propagated how?

Answer 1

Social factors, poverty, crowding, disease, Airborne

Question 2

TB in lungs form?

Answer 2

Caseating granulomas

Question 3

Children spreaders of TB?

Answer 3

Rarely, they are ‘spill over’ host.

Adolescents spread easily

Question 4

Main: ‘home’ of TB in lung?

Answer 4

Lung Macrophage, then lymph nodes, present to T-cell
Back to lung
Granuloma

Question 5

When is the worst time in your life to inhale TB?

Answer 5

Infant

Also get severe forms, meningitis, military

Question 6

Adolescents are infectious with which form of TB?

Answer 6

Pulmonary, can get own cavities and spread it

Question 7

Pulmonary TB has what classic thing?

Answer 7

Ghon focus (transient lesion)

Question 8

Which lung lymph nodes are most affected in child TB?

Answer 8

Sub-carinal nodes

Question 9

See an x-ray that looks like bad pneumonia, how to tell if bacteria v. TB?

Answer 9

TB - walks into your office, not unwell, not in ICU.

Bacterial: very unwell

Question 10

What does TB do to the airway?

Answer 10

Compresses the airway on CXR

Question 11

When does adult-type disease develop in kids?

Answer 11

Past around age of 10

Question 12

What is the most common manifestation of extra-pulmonary tB?

Answer 12

Cervical lymphadenitis

• persistent mass
• no local cause
• no response to Abx

Question 13

3 common TB diagnosis?

Answer 13

• Zeil-Neison
• immunofluorescence
• culture

Question 14

TB skin test tests what?

Answer 14

• Exposure, not active disease.

- not sensitive, not a rule out test

Question 15

What is the mantoux method?

Answer 15

Measure transverse diameter of the swelling with pen
>10mm: non-HIV infected
>5mm: HIVinfected

Question 16

TST and T-cell assays for TB tell us what?

Answer 16

About infection

NOT about disease

Question 17

What symptoms in children with suspected TB?

Answer 17

> 2weeks cough
-failure to thrive >3/12
-fatigue lethargy
PERSISTENT symptoms

Question 18

TB lymph node, how to sample it?

Answer 18

Fine needle aspirate

Excision also biopsy (not incisional)

Question 19

New TB test in children?

Answer 19

Xpert MTB/RIF
More sensitive than smear, not as much as culture
Gives answer in 2 hours

Question 20

How to dx TB meningitis?

Answer 20

LP
Raised ICP
High protein
Less cells
Lymphocytes

Question 21

Rx of TB in children

Answer 21

2/12 intensive (ING,Rif,PZA)

4/12 continuation (INH, Rif)

Question 22

BCG prevents against?

Answer 22

Miliary and disseminated TB

Question 23

Why important to treat children with HIV?

Answer 23

Treat early so you can give BCG vaccine

ART for pregnant mothers too