Pulmonary Tuberculosis in Children: Clinical Case and Viva QnA

Clinical Case: Pulmonary Tuberculosis in Children

Case Presentation

A 6-year-old boy presents with a 3-month history of persistent cough, intermittent fever, and weight loss. His mother reports night sweats and decreased appetite. The family recently immigrated from a high TB-endemic country.

Physical Examination

• Weight: Below the 5th percentile for age
• Temperature: 38.5°C
• Respiratory rate: 28 breaths/min
• Chest auscultation: Bronchial breathing in the right upper zone
• Palpable cervical lymphadenopathy

Investigations

• Chest X-ray: Right upper lobe infiltrate with hilar lymphadenopathy
• Mantoux test: 18mm induration
• IGRA (QuantiFERON-TB Gold): Positive
• Sputum microscopy: Acid-fast bacilli seen
• GeneXpert MTB/RIF: Mycobacterium tuberculosis detected, Rifampicin resistance not detected
• HIV test: Negative

Diagnosis and Management

Diagnosed with pulmonary tuberculosis. Started on standard four-drug regimen: Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol. Contact tracing initiated for family members.

Varieties of Presentation of Pulmonary Tuberculosis in Children

1. Primary Pulmonary TB

   Most common in young children. Features include persistent non-remitting cough, low-grade fever, and failure to thrive. Chest X-ray may show hilar lymphadenopathy and/or lung infiltrates.

2. Reactivation TB (Post-primary)

   More common in adolescents. Presents with chronic cough, hemoptysis, weight loss, and night sweats. Chest X-ray often shows upper lobe infiltrates and cavitations.

3. Miliary TB

   Severe form seen in young or immunocompromised children. Presents with high fever, severe weight loss, respiratory distress, and sometimes meningeal signs. Chest X-ray shows diffuse miliary nodules.

4. Endobronchial TB

   Presents with persistent wheezing, cough, and sometimes atelectasis due to bronchial obstruction. May mimic foreign body aspiration or asthma.

5. Pleural TB

   More common in older children and adolescents. Presents with chest pain, dry cough, and sometimes fever. Chest X-ray shows pleural effusion, often unilateral.

Knowledge Check: Question and Answers

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30