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