Tuberculosis in Infants and Children

Gabriella S. Lamb; Jeffrey R. Starke

doi:10.1128/microbiolspec.TNMI7-0037-2016

Chapter 32 : Tuberculosis in Infants and Children

Authors: Gabriella S. Lamb¹, Jeffrey R. Starke²

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Affiliations: 1: Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; 2: Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030

Content Type: Monograph

Publication Year: 2017

Category: Bacterial Pathogenesis; Clinical Microbiology

Book DOI: 10.1128/9781555819866

Chapter DOI: 10.1128/microbiolspec.TNMI7-0037-2016

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Abstract:

The clinical expression of disease caused by Mycobacterium tuberculosis is greatly different in infants, children, and adolescents from what it is in adults ( 1 , 2 ). 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 ( 3 ).

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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Tuberculosis in Infants and Children

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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.)

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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.)

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Figure 2

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

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Figure 2

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

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Figure 3

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

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Figure 3

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

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Figure 4

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

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Figure 4

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

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Figure 5

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

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Figure 5

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

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Figure 6

Reactivation-type tuberculosis in an adolescent boy.

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Figure 6

Reactivation-type tuberculosis in an adolescent boy.

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Figure 7

A tuberculous pleural effusion in an adolescent girl.

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Figure 7

A tuberculous pleural effusion in an adolescent girl.

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Figure 8

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

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Figure 8

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

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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.

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Figure 9

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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.

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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.

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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.

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Figure 11

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