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Chapter 30 : Tuberculosis in Infants and Children

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Abstract:

This chapter focuses on the fundamental nature of exposure and infection of pediatric tuberculosis, emphasizing how and why children should be approached differently from adults. The effects of these differences on the public health approach to tuberculosis control in children are also explained in the chapter. Disease occurs when signs or symptoms or radiographic manifestations caused by become apparent. Infants are more likely to experience signs and symptoms, probably because of their small airway diameters relative to the parenchymal and lymph node changes in primary tuberculosis. The hallmark of primary pulmonary tuberculosis is the relatively large size and importance of the lymphadenitis compared with the less significant size of the initial parenchymal focus. The most common manifestations are at the anatomic site of the existing tuberculosis, but new onset of tuberculomas, lymphadenopathy, and abdominal manifestations can occur. As with tuberculin skin test (TSTs), gamma interferon release assays (IGRAs) cannot distinguish between latent infection and disease, and a negative result from these tests cannot exclude the possibility of tuberculosis infection or disease in a patient with findings that raise suspicion for these conditions. The chapter gives current recommendations for use of gamma IGRAs in children. The main form of nucleic acid amplification studied in children with tuberculosis is the PCR, which uses specific DNA sequences as markers for microorganisms. An expert in tuberculosis always should be involved in the management of children with drug-resistant tuberculosis infection or disease.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30

Key Concept Ranking

Bacterial Pneumonia
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Pleural Effusion
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Magnetic Resonance Imaging
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Figures

Image of Figure 1.
Figure 1.

Tuberculosis (TB) case rates by age group for children, 1993–2001. (Data in the public domain, courtesy of the Centers for Disease Control and Prevention).

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 2.
Figure 2.

Early collapse-consolidation lesion in a child with tuberculosis. Mediastinal adenopathy also is present on the right side.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 3.
Figure 3.

Slightly more extensive right-sided adenopathy with atelectasis in a 2-year-old with tuberculosis.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 4.
Figure 4.

Well-formed collapse-consolidation lesion on the right, with large mediastinal and hilar adenopathy and atelectasis.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 5.
Figure 5.

Tuberculous pneumonia with bowing of the horizontal fissure. Children with this finding may have an associated bacterial infection.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 6.
Figure 6.

Reactivation-type tuberculosis in an adolescent boy.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 7.
Figure 7.

A tuberculous pleural effusion in an adolescent girl.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 8.
Figure 8.

Miliary tuberculosis in an infant. The child presented with fever and respiratory distress.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Image of Figure 9.
Figure 9.

A helpful technique for applying the Mantoux TST on a child. The hand is anchored on the side of the child’s arm, providing stability. The tuberculin is injected in a lateral direction.

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
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Tables

Generic image for table
Table 1.

Median age of children (less than 20 years old) with tuberculosis by predominant site, United States, 1988

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
Generic image for table
Table 2.

Symptoms and signs of childhood pulmonary tuberculosis

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
Generic image for table
Table 3.

Comparison of chest radiographs of pulmonary tuberculosis in adults and children

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
Generic image for table
Table 4.

Amount of induration from a Mantoux TST considered positive in children

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30
Generic image for table
Table 5.

Commonly used drugs for the treatment of tuberculosis in children

Citation: Starke J. 2011. Tuberculosis in Infants and Children, p 456-475. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch30

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