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Chapter 32 : Tuberculosis in Infants and Children

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Abstract:

The clinical expression of disease caused by is greatly different in infants, children, and adolescents from what it is in adults ( ). Much adult pulmonary tuberculosis is caused by a reactivation of organisms which were lodged in the apices of the lungs during hematogenous dissemination at the time of infection. Childhood tuberculosis is usually a complication of the pathophysiologic events surrounding the initial infection. The interval between infection and disease is often long (years to decades) in adults but is often only weeks to months in small children. Children are more prone to developing extrapulmonary tuberculosis but rarely develop contagious pulmonary disease. As a result of the basic differences in pathophysiology of tuberculosis between adults and children, the approach to diagnosis, treatment, and prevention of infection and disease in children is necessarily different ( ).

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figures

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Figure 1

Tuberculosis (TB) case rates by age group for children, 1993 to 2015. (Data in the public domain, courtesy of the CDC.)

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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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: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 3

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

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 4

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

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 5

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

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 6

Reactivation-type tuberculosis in an adolescent boy.

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 7

A tuberculous pleural effusion in an adolescent girl.

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 8

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

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 9

Magnetic resonance imaging showing abnormal enhancement along the basilar cisterns, acute ischemia or possibly cerebritis involving the right caudate head, right putaminal and possibly right globus pallidus, ventriculomegaly (ventriculoperitoneal shunt in place), and enhancement along multiple cranial nerves.

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Figure 10

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: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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Image of Figure 11
Figure 11

An algorithm for the use of the TST and IGRAs in children. Entry into the algorithm assumes that the child has at least 1 risk factor for TB infection. Note: many experts use age <2 years as the starting point. Reprinted from reference , with permission from the American Academy of Pediatrics Committee on Infectious Diseases.

Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children, p 541-569. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0037-2016
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