Diagnosis of Pediatric Tuberculosis

Pediatric TB Topics Introduction Clinical Features Diagnostic Approach Special Considerations

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

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