Tuberculosis

Question 1

Recognise clinical features of TB in children

Answer 1

• 1” asymtomatic
  
  • ​50% infants
  • 90% older children
  • local inflammatory reaction limits progression
• 1” symptomatic
  
  • Fever
  • Anorexia/ weight loss
  • Persistent wet, severe cough- weeks/months
  • CXR changes
  • local host response fails to contain inhaled tubercle bacilli –> reginal lymphatic spread
  • collapse/ consolidation of affected lung
• Post-primary TB
  
  • ​tuberculous meningitis
  • widely disseminated disease- bones, joints, kidneys, pericardium, CNS

Question 2

Treatment and problems with adherence

Answer 2

• Triple/ quadruple therapy
  
  • rifampicin
  • isoniazid
    
    • ​pyridoxine given weekly to prevent the peripheral neuropathy associated with isoniazid (after puberty)
  • pyrazinamide
  • ethambutol
• After 2 months reduced to r and i only
• Treatment for uncomplicated = 6m
• Longer treatment for disseminated disease/ TB meningitis (+ dexamethosone)
• Asymptomatic children who are Mantoux-+ve: r and i 3 months