Tuberculosis (TB) In Children: Types, Causes, Symptoms, And Treatment

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Tuberculosis (TB) is a chronic bacterial infection. It is a rare but contagious disease caused by Mycobacterium tuberculosis. It mainly affects the lungs but may also infect lymph nodes, bones, skin, kidneys, brain, or spine (1).

Around 1.2 million children under 15 years fall ill with TB every year (2). The Centers for Disease Control and Prevention (CDC) explains that TB in children younger than 15 years is a threat to public health as it indicates a recent transmission. So the chance of active tuberculosis among close family members is high. Moreover, TB in young children can be life-threatening (3). Read this post to learn more about the symptoms, complications, diagnosis, prevention, and treatment of TB in children.

Types Of TB In Children

The following are the different stages of TB (1).

  • Exposed: This is when the child comes in contact with a TB-positive person but has a negative TB skin and blood test, a normal appearance of the lungs on an x-ray, and has no correlating symptoms.
  • Latent TB infection: This happens when the child has TB bacteria in the body but is asymptomatic. The child’s immune system causes the TB bacteria to be inactive. They test positive for TB on a blood or skin test but have a normal chest x-ray and no symptoms. They cannot spread the infection to others.
  • TB disease: This is when the child exhibits the signs and symptoms of an active infection. Their blood or skin test is usually positive but may also be false-negative sometimes. Chest X-rays may be used to check for typical features of tuberculosis., but the testing shows active disease in the lungs or other sites in the body. Most children with TB are not infectious to others because of the low bacillary load.

Causes Of TB In Children

TB is caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis). Most children infected with M. tuberculosis do not develop active infection and remain latent.

The bacteria is spread through the air when an infected person coughs, sneezes, speaks, sings, or laughs. A child becomes infected only on repeated contact with the bacteria. It does not spread by sharing personal items such as utensils, towels, clothing, bedding, cups, a toilet, or other items that a person with TB has touched (1).

Symptoms Of TB In Children

The symptoms of TB differ are not the same in every child. They may vary according to the child’s overall health, age, site of infection, and severity of the condition. Some symptoms of TB in children include (1):

  • Fever
  • Significant weight loss or no weight gain for a prolonged period
  • Poor growth
  • Cough
  • Swollen glands

The following are some symptoms of active TB in older children.

  • Cough that lasts longer than three weeks
  • Chest pain
  • Blood in sputum
  • Fatigue
  • Weakness
  • Swollen glands
  • Appetite loss
  • Fever
  • Weight loss

In some children, tuberculosis may spread to other organs from the primary site of infection through the bloodstream. It may affect any vital organ in the body, and the symptoms will vary according to the site of infection.

  • Brain: Convulsions, lack of orientation, and loss of consciousness
  • Bone and joints: Pain, swelling, and limpness
  • Gastrointestinal tract: Abdominal pain and vomiting
  • Water in the lungs (pleural effusion): Chest pain, heaviness in the chest, and difficulty in breathing

The treatment for such an infection needs extensive treatment (4).

Risk Factors And Complications Of TB In Children

The following factors may make children more susceptible to TB infection (5) (6).

  • Living with or being exposed to those with TB
  • Overcrowded living spaces
  • Populations who are medically underserved
  • Homeless population
  • Living in countries where TB is prevalent
  • Children living in group settings
  • Children with impaired immune systems
  • Unimmunized children
  • Malnourished children
  • Children with diabetes or HIV
  • Children taking medicines such as long-term systemic corticosteroid therapy or chemotherapy as it weakens their immune system

Diagnosis Of TB In Children

The doctor will ask for a detailed medical and family history and note all symptoms of the child. They will also examine all physical signs of the child.

TB is diagnosed with a tuberculin skin test (TST). A small amount of testing material is injected into the skin, and the doctor notes the development of a bump. The size of the bump will indicate whether the test is positive or not. Local redness in the area doesn’t necessarily indicate infection.

The doctor may perform a blood test called QuantiFERON-TB Gold (QFT) or interferon-gamma release assays (IGRA), chest x-ray, sputum test, CT scan, or bronchoscopy for the child (7). Sputum testing is difficult in a child as children don’t expectorate sputum. So, gastric aspirate may be tested, but yields are very low. A TB skin test may be advised for children:

  • With recent exposure to individuals with TB
  • With an X-ray that looks like TB
  • Having symptoms of TB
  • Who come from countries where TB is prevalent
  • Children with HIV

Yearly skin tests for TB are advised for children who have HIV or live in a detention facility. Children exposed to high-risk people should be tested every two to three years.

Children may be asked to get TB skin testing from ages four to six and 11 to 16 if they:

  • Have a parent from a high-risk country
  • Have traveled to a high-risk area
  • Live in a densely populated area (6)

Treatment For TB In Children

The treatment plan for TB is designed based on the child’s age, the site and extent of the disease, and tolerance towards specific medicines. The treatment may include (5):

  • Short-term hospitalization
  • Anti-tubercular drugs
  • For latent TB in children, isoniazid and/or rifampicin for 3-6 months as advised by the doctor
  • For active TB in children, a combination of three to four medicines, including isoniazid, rifampin, pyrazinamide, or
  • streptomycin for up to six months or more, as advised by the doctor

Children usually feel better within a few weeks after the treatment starts. After two weeks of treatment, the child is no longer contagious. However, it is essential to complete the entire course of medication for maximum efficacy and to prevent relapse and drug resistance.

Prevention Of TB In Children

The main way to prevent TB in children is to take the BCG (Bacillus Calmette–Guérin) vaccine. Serious TB complications can be prevented by treating latent TB, so it does not become active. Diagnosing and treating active TB cases among adults can help prevent the spread of TB to children. Completion of the full course of treatment is absolutely essential.

If a child has TB, ask the doctor when it is safe to return to school. In addition, children in homes with active TB cases should be screened and provided preventive treatment (8).

When To Call The Doctor?

There may be some side effects from the TB medicines. Call your healthcare provider if you notice the following symptoms (7).

  • Nausea
  • Vomiting
  • Loss of appetite
  • Yellowish discoloration of the eyes or the skin
  • Abdominal pain
  • Tingling sensation of the toes or the fingers
  • Skin rashes
  • Spontaneous bleeding
  • Feeling dizzy
  • Tingling or numbness around the mouth
  • Easy bruising
  • Blurred vision
  • Ringing sensation in ears
  • Hearing loss

Frequently Asked Questions

  1. What is multidrug-resistant TB (MDR TB)?

When TB bacteria become resistant to two or more of the most important TB medicines— INH and RIF, it is called multidrug-resistant, or MDR TB. Children with MDR TB disease need special medicines known as second-line anti-tubercular drugs. (7).

  1. What happens if my child skips one dose?

If the child misses one dose, skip it and take the next dose as scheduled. Ensure your child’s healthcare provider is informed when this happens (7). The healthcare provider will add extra doses to compensate for the missed doses.

  1. Why does the treatment for TB take so long?

The duration of treatment for TB is long because the TB bacteria take more time to die. It takes at least six months to clear up all the bacteria from the child’s body (7). If the infection is in the brain or bones, it will take longer.

  1. How can I keep my child from spreading TB?

Completing the entire course of medicines as advised is the best way to contain TB infection. Also, understand that children with TB don’t spread the infection too much. They quickly become non-infectious after starting anti-tubercular therapy. Also, encourage the child to:

  • Cover their mouths with tissue paper when they cough, sneeze, or laugh.
  • Put the tissue in a closed bag and throw it away.
  • Stay at home and away from school only as long as advised by the doctor.
  • Avoid proximity or close contact with other children when sick.
  • Sleep in separate rooms (for older kids) when unwell (7).

TB is not a disease of the past. Contact your healthcare professional if your child is exposed to a TB-positive patient or exhibits symptoms similar to a TB infection. Prevention is the best way to eradicate TB. If your child is diagnosed with TB, ensure the completion of the entire course of treatment.

References:

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Dr. Shaon Mitra

(MD)
Dr. Shaon Mitra is an experienced consultant pediatrician and neonatologist attached to several hospitals in Kolkata, West Bengal, including Bellevue Clinic, ILS Hospitals Salt Lake, and Park View Superspeciality Hospital. Previously, she worked as an Assistant Professor in Pediatrics at KPC Medical College & Hospital. In addition to being a certified Medical Teacher under the West Bengal University of Health... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more

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