Tuberculosis

Question 1

What is tuberculosis?

Answer 1

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person.

TB usually affects the lungs, but it can affect other parts including:

=> bones (such as the spine)
=> brain
=> lymph glands
=> abdomen.

Question 2

When should you suspect TB in children?

Answer 2

=> Overseas contact

=> HIV +ve

Question 3

What are the signs and symptoms in children with TB?

Answer 3

1. Anorexia
2. Low fever
3. Failure to thrive
4. Weight loss / difficulty putting on weight
5. Malaise / feeling generally unwell
6. Cough >3months (common but may be absent)
7. Night sweats
   * Children with latent TB = asymptomatic
   * Can lead to TB meningitis in children

Question 4

How is TB in children diagnosed?

Answer 4

1. Tuberculin tests (Mantoux test) - small amount of TB proteins (antigens) are inserted into the skin and a reaction = +ve test
2. Interferon-gamma release assays (blood test)
3. Culture + Ziehl-Neelsen stain of sputa x3
4. CXR: consolidation & cavities; mililary spread (fine white dots on CXR) is rare but severe

Question 5

What is the treatment for TB in children?

Answer 5

1. Get expert help
2. 6-month supervised plan
3. Isoniazid 15mg/kg/PO 3x week
   Rifampicin 15mg/kg/PO 3x week
   Pyrazinamide (first 2 months only) 50mg/kg PO 3x week
4. Monitor U&E, LFT before and during treatment
5. Stop Rifampicin if bilirubin rises (hepatitis)
   Isoniazid may cause neuropathy (give concurrent pyridoxine)

*prophylaxis for TB with HIV = co-trimoxazole