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Tuberculosis in Infants and Children

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  • Authors: Gabriella S. Lamb1, Jeffrey R. Starke2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; 2: Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; 3: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
  • Received 25 January 2017 Accepted 01 February 2017 Published 07 April 2017
  • Jeffrey R. Starke, jrstarke@texaschildrens.org
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  • Abstract:

    One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.

  • Citation: Lamb G, Starke J. 2017. Tuberculosis in Infants and Children. Microbiol Spectrum 5(2):TNMI7-0037-2016. doi:10.1128/microbiolspec.TNMI7-0037-2016.

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/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016
2017-04-07
2017-09-24

Abstract:

One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.

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Figures

Image of FIGURE 1
FIGURE 1

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

Source: microbiolspec April 2017 vol. 5 no. 2 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.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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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.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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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.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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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.

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Image of FIGURE 6
FIGURE 6

Reactivation-type tuberculosis in an adolescent boy.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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Image of FIGURE 7
FIGURE 7

A tuberculous pleural effusion in an adolescent girl.

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Image of FIGURE 8
FIGURE 8

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

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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Image of FIGURE 9
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.

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Image of FIGURE 10
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.

Source: microbiolspec April 2017 vol. 5 no. 2 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 107 , with permission from the American Academy of Pediatrics Committee on Infectious Diseases.

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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Tables

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TABLE 1

Childhood tuberculosis cases with any extrapulmonary involvement by age group and selected sites of disease, United States, 1993 to 2015

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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TABLE 2

Symptoms and signs of childhood pulmonary tuberculosis

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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TABLE 3

Comparison of chest radiographs of pulmonary tuberculosis in adults and children

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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TABLE 4

First-line drugs for the treatment of tuberculosis in children

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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TABLE 5

Drugs used for treatment of MDR tuberculosis in children

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016

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