Diagnosis of Pediatric Tuberculosis
Key Points
- Pediatric TB diagnosis is challenging due to paucibacillary nature and non-specific symptoms
- Systematic approach combining multiple diagnostic tools is essential
- High index of suspicion needed in endemic areas
- Contact history with TB patient is crucial diagnostic clue
Introduction
Pediatric tuberculosis presents unique diagnostic challenges due to:
- Paucibacillary nature of disease
- Difficulty in obtaining adequate specimens
- Non-specific clinical presentation
- Limited validation of diagnostic tests in children
Clinical Manifestations
Common Symptoms
- Persistent fever (>2 weeks)
- Chronic cough
- Weight loss or failure to thrive
- Reduced playfulness/activity
- Night sweats
- Lymphadenopathy
Age-specific Presentations
- Infants (<1 year):
- Acute severe pneumonia
- Disseminated disease
- Meningitis
- Hepatosplenomegaly
- Young children (1-4 years):
- Lymph node disease
- Primary complex
- Less severe presentations
- Older children (>5 years):
- Adult-type disease
- Cavity formation
- More localized disease
Systematic Diagnostic Approach
1. History Taking
- Contact with TB case
- Duration of symptoms
- Previous TB treatment
- Risk factors:
- HIV status
- Malnutrition
- Immunosuppression
2. Physical Examination
- Growth assessment
- Nutritional status
- Lymph node examination
- Respiratory system examination
- BCG scar examination
3. Basic Investigations
- Tuberculin Skin Test (TST/Mantoux)
- ≥10mm: positive in non-HIV
- ≥5mm: positive in HIV/severe malnutrition
- Chest X-ray findings
- Hilar lymphadenopathy
- Primary complex
- Miliary pattern
- Pleural effusion
- Cavitary lesions
4. Specimen Collection
- Early morning gastric aspirates (3 consecutive days)
- Induced sputum
- Nasopharyngeal aspirates
- Lymph node aspiration/biopsy
- CSF analysis in suspected TB meningitis
Special Considerations
Diagnostic Challenges in Specific Situations
HIV Co-infection
- More rapid disease progression
- Atypical presentations
- False-negative TST common
- Higher risk of disseminated disease
Extrapulmonary TB
- Site-specific sampling needed
- More common in young children
- May require surgical intervention for diagnosis
Drug-Resistant TB
- Contact history crucial
- Need for drug susceptibility testing
- Consider in treatment failure cases
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
