Mini-symposium: Childhood tuberculosisClinical manifestations of tuberculosis in children
Section snippets
Pulmonary TB
Pulmonary parenchymal disease and associated intrathoracic adenopathy are the most common clinical manifestations of TB in children. Most have a positive tuberculin skin test (TST); however, skin test anergy is common in immunocompromised or malnourished patients. Inhalation of bacilli into a terminal airway can result in a Ghon complex, comprising the initial focus of infection, the draining lymphatic vessels and enlargement of the regional lymph nodes (Fig. 1). There are four potential
Superficial lymph nodes
Superficial lymphadenopathy, occurring in 10–15% of children, accounts for almost 50% of extrapulmonary disease. Historically, it has been caused by drinking unpasteurised milk infected with Mycobacterium bovis, but now the most common route is haematogenous infection with M. tuberculosis. Symptoms generally present 6–12 months after initial infection, and the mean age at diagnosis tends to be higher than children diagnosed with non-tuberculous mycobacterial (NTM) infections. Most
Miliary/disseminated TB
Miliary TB accounts for 1–2% of all cases of TB. It is more commonly seen in infants and children under 5 years of age and in immunocompromised hosts, including patients with rheumatological conditions receiving tumour necrosis factor-α agents.33 Miliary TB is due to lymphohaematogenous spread, and multiorgan involvement is common. Organs that receive the greatest vascular supply are at highest risk. The onset is usually 2–6 months after the initial infection; however, disease progression can
Conclusion
The spectrum of paediatric TB disease is influenced by host factors such as age and immunological status. Although the most common presentation is with thoracic disease, the possibility of disseminated or focal extrathoracic disease must be considered in neonatal and immunocompromised populations. Due to limitations in diagnostic modalities and low culture yield in paediatric patients, the diagnosis of TB often rests upon a positive TST, chest radiograph findings, compatible clinical findings,
Practice points
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Only 5–10% of immunocompetent children progress from tuberculosis infection to disease.
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Risk of progression to disease and risk of extrapulmonary tuberculosis are dependent upon host factors such as patient age and immune status.
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The most common sites of infection are the lung and superficial lymph nodes, together accounting for approximately 90% of disease in children.
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Rapidly progressive forms of disease include central nervous system involvement and disseminated (miliary) tuberculosis; later
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