Childhood Tuberculosis: Q&A For Primary Care Physicians

Authors: Madhukar Pai, MD, PhD—Author and Series Editor
Number of pages: 3
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Overview: GPs frequently see children in their clinical practice, and should be alert to the possibility of pediatric TB, especially in malnourished children. Children with TB often present with vague, non-specific symptoms, and this makes it hard to suspect and diagnose TB. Symptoms could include chronic fever, cough, weight loss, fatigue, loss of appetite, failure to gain weight, and lymph node enlargement. History of contact with an adult with TB is therefore a very important component of history that should be elicited. There is no adequate gold standard test for childhood TB, and diagnosis requires multiple tests. Smears for acid-fast bacilli (AFB) are often negative because of the low numbers of AFB in childhood TB. Therefore, liquid culture and molecular tests (Xpert MTB/RIF) will be most helpful, along with signs, symptoms, chest radiology, evidence of TB infection (e.g. positive Mantoux skin test), and history of contact with active TB. All children who have not been treated previously and do not have other risk factors for drug resistance should receive a WHO-approved first-line treatment regimen for a total of 6 months. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide and ethambutol. The continuation phase should consist of isoniazid and rifampicin given for 4 months. Daily treatment is preferable to intermittent therapy. Drug dosages are calculated according to weight (not age). Adherence to the full course of anti-TB therapy is very important to ensure high cure rates. In general, children tolerate first-line anti-TB therapy very well with low risk of toxicity.

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