Tuberculosis in children: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Children must be evaluated with a complete assessment, which includes | *Children must be evaluated with a complete assessment, which includes a meticulous medical history, physical examination, [[TST]], [[Chest X-ray]], Sputum or gastric aspirate studies (microscopy and culture), and HIV testing. | ||
*Bacteriological testing might be difficult among children, but it should be performed whenever possible. | *Bacteriological testing might be difficult among children, but it should be performed whenever possible. | ||
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! style="background: #4479BA | ! style="background: #4479BA;" colspan=2| {{fontcolor|#FFF|Diagnostic Approach in Children with Suspected Tuberculosis}} | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 200px;" | History and Symptoms | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Evaluate for close contact with a case of TB. <br> | |||
*Symptoms include [[cough]], [[fever]], [[poor appetite]], [[weight loss]], [[lethargy]], [[fatigue]], altered growth development. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Physical Examination | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*The physical examination might be unremarkable in children. <br> | |||
*Extrapulmonary tuberculosis presents with abnormal physical findings. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Tuberculin Skin Test | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Important for evaluate children with no history of close contact and to screen for TB infection. <br> | |||
*> 10 mm is considered positive in immunocompetent children. <br> | |||
*In immunosupressed children, > 5mm is considered positive. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Chest X-ray | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Bacteriological Tests | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | HIV Test | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
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|} | |} | ||
Revision as of 18:01, 23 September 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Tuberculosis Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Tuberculosis in children On the Web |
American Roentgen Ray Society Images of Tuberculosis in children |
Risk calculators and risk factors for Tuberculosis in children |
Overview
Screening for Tuberculosis
Symptom-based Screening Approach
Algorithm adapted from Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children[1]
Child in close contact with confirmed tuberculosis case | |||||||||||||||||||||||||||||||||||||||||||||||||
< 5 yrs old | > 5 yrs old | ||||||||||||||||||||||||||||||||||||||||||||||||
Asymptomatic | Symptomatic | Symptomatic | Asymptomatic | ||||||||||||||||||||||||||||||||||||||||||||||
Administer INH 10 mg/kg/d x 6 months | No preventive treatment is recommended. | ||||||||||||||||||||||||||||||||||||||||||||||||
If the child develops symptoms | If the child develops symptoms | ||||||||||||||||||||||||||||||||||||||||||||||||
Confirm the diagnosis of TB with:
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Screening in Children with HIV
Algorithm adapted from Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children[1]
IPT: Isoniazid preventive therapy (INH 10 mg/kg/d x 6 months)
Child with HIV and older than 1 year | |||||||||||||||||||||||||||||||||||||||||||||||||||
Does the patient has any of the following symptoms?
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Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||
Assess for the diagnosis of TB (TST, chest X-ray, sputum studies) and rule out other diseases | Does the patient has any of the following contraindications for IPT?
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TB confirmed | TB ruled out, other diagnosis confirmed | Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||
Administer 2HRZE/4HR regimen | Give appropriate treatment for the disease and consider IPT | Do not administer IPT | Administer IPT | ||||||||||||||||||||||||||||||||||||||||||||||||
Diagnosis
- Children must be evaluated with a complete assessment, which includes a meticulous medical history, physical examination, TST, Chest X-ray, Sputum or gastric aspirate studies (microscopy and culture), and HIV testing.
- Bacteriological testing might be difficult among children, but it should be performed whenever possible.
Diagnostic Approach in Children with Suspected Tuberculosis | |
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History and Symptoms |
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Physical Examination |
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Tuberculin Skin Test |
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Chest X-ray | |
Bacteriological Tests | |
HIV Test |
Treatment
Tuberculosis in Children ▸ Drug Susceptible TB ▸ MDR-TB ▸ XDR-TB |
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