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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, [email protected]
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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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2017-04-07
2019-08-18

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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Tuberculosis in Infants and Children
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Citation: Lamb G, Starke J. 2017. Tuberculosis in infants and children. microbiolspec 5(2): doi:10.1128/microbiolspec.TNMI7-0037-2016
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.fig1
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.)

Source: microbiolspec April 2017 vol. 5 no. 2 doi:10.1128/microbiolspec.TNMI7-0037-2016
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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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microbiolspec/5/2/TNMI7-0037-2016-fig9.gif
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.

Source: microbiolspec April 2017 vol. 5 no. 2 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.
microbiolspec/5/2/TNMI7-0037-2016-fig10_thmb.gif
microbiolspec/5/2/TNMI7-0037-2016-fig10.gif
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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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.
microbiolspec/5/2/TNMI7-0037-2016-fig11_thmb.gif
microbiolspec/5/2/TNMI7-0037-2016-fig11.gif
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

Tuberculosis in Infants and Children
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Citation: Lamb G, Starke J. 2017. Tuberculosis in infants and children. microbiolspec 5(2): doi:10.1128/microbiolspec.TNMI7-0037-2016
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.T1
TABLE 1
Childhood tuberculosis cases with any extrapulmonary involvement by age group and selected sites of disease, United States, 1993 to 2015
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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
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.T2
TABLE 2
Symptoms and signs of childhood pulmonary tuberculosis
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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
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.T3
TABLE 3
Comparison of chest radiographs of pulmonary tuberculosis in adults and children
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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
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.T4
TABLE 4
First-line drugs for the treatment of tuberculosis in children
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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
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0037-2016.T5
TABLE 5
Drugs used for treatment of MDR tuberculosis in children
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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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