TB

Question 1

LTBI in < 5 year and immunosuppressed (HIV +)

Answer 1

INH 10mg/kg daily x 6 months

Question 2

TST/PPD/Mantoux

Answer 2

2TU/0,1 PPD 
Intradermal injection 
48-72 hours
measure induration
5mm or more in HIV or malnutrition all other children 10mm or more 

false negative - miliary TB, TBM, HIV, Measles, Immunosuppresive drugs, severe malnutrition, recent TB exposure

false positive - BCG, Atypical mycobacteria, repeated skin tests

Question 3

4 symptoms indicating TB in children

Answer 3

FTT
Prolonged fever without a cause
chronic suppurative non-remittent cough
loss of playfulness

Question 4

Intrathoracic lymphadenopathy

Answer 4

hilar/paratracheal lymph nodes 
lateral x-ray 
FTT/weight loss 
fever/night sweats 
coughing-chronic non-remittent productive 
fatigue

Question 5

Progressive primary focus

Answer 5

GHON focus complicates 
cavitation
FTT/weight loss 
Fever/night sweats 
coughing 
fatigue

Question 6

Lympho-bronchial TB

Answer 6

press on airway - collapse
incomplete narrowing - hyperinflation
ulcerating nodes - collapse-consolidation - expansile caseating pneumonia
chronic lung damage/ disease = bronchiectasis
symptoms and signs
- FTT/weight loss
- fever/night sweats
- coughing
- fatigue
- acute signs of pneumonia/ hyperinflation/ acute distress

Question 7

4 most common sites for extra-thoracic TB

Answer 7

TB meningitis
TB lymphadenitis
Disseminated/Miliary TB
Perinatal TB

Question 8

TB meningitis

Answer 8

obstruction to CSF flow 
CN palsies 
Vasculitis - stroke 
Obstructive communicating hydrocephalus 
- ventricles are fine 
- obstruction is at absorption
gradual onset 
irritability, headache, vomiting 
focal neurological signs/convulsions 
Disease progression in 3 stages 
stage 1 - meningeal irritation, fever, lethargy, no focal neurological signs, no hydrocephalus, consciousness normal
stage 2 - confusion and/or focal neurological signs (squints, hemiparesis) 
stage 3 - stupor or delirium and/or neurological signs (paraplegia, hemiplegia) - decorticate and decerebrate

Question 9

TB lymphadenitis

Answer 9

cervical nodes 
EPTB in children 
painless, matted and firm 
can lead to sinuses - scrofula 
NB - DDx Lymphoma, Bacterial Abscesses, Chronic fungal infections

Question 10

Disseminated/Miliary TB

Answer 10

very young <2yr and malnourished 
first few months after primary infxn 
symptoms and signs 
- wasting 
- HSM 
- Lymphadenopathy 
- Respiratory Symptoms 
- Fever 
- Poor feeding

Question 11

Diagnosis

Answer 11

1. Exposure = History
   - TB contact
   - symptoms and signs
2. TB infection
   - TST < 5 years and immunocompromised
3. TB disease
   - CXR
   - Sputum/aspirates
   coughing, induced, suction, nasogastric aspirate
   - EPTB samples

Question 12

TB testing

Answer 12

Gene Xpert - paeds = only sputum + CSF
TB - MCS - paeds culture NB
line probes
TB PCR

Question 13

Treatment
< 5 years
HIV positive
uncomplicated/ sputum negative PTB = 8y

Answer 13

2 months = R + H + PZA

4 months = R + H

Question 14

Treatment
Complicated TB - high bacillary load, retreatment
> 8 years

Answer 14

2 months = R + H + PZA + E

4 months = R + H

Question 15

Treatment: TB meningitis

Answer 15

up to 1 year with 4 drugs - 4th drug Ethionamide

Question 16

Treatment: Congenital TB

Answer 16

4 drugs for 6 months

Question 17

When to give steroids

Answer 17

TB meningitis, pericarditis, miliary TB - severe response

LN pressing on bronchus

Question 18

INH prophylaxis

Answer 18

10mg/kg daily for 6 months

TST positive - HIV

Question 19

TB and HIV

Answer 19

Rifampicin - jaundice and hepatotoxicity
start TB treatment 2-4w then add HIV drugs
preferably complete TB treatment before HIV treatment
increase Ritonavir dosage to slow both drugs down