TB CASE

Friday 20/6/2014Dr: Khaled Saad

A 15-year-old high school student presented to a specialty clinic with frequent cough, hemoptysis, weight loss, fatigue, and anemia of 6 months duration. His chest radiograph showed extensive right upper lobe infiltrates and multiple cavitary lesions. Sputum smears were positive for (AFB).

When the pediatric pulmonologist initially saw this patient and suspected active TB, he was accompanied by his mother and 5 month old brother. The infant appeared healthy with no signs and symptoms of TB.

In regards to the infant brother, which is the most appropriate response by the local health department?

1. The infant is not symptomatic and in no immediate danger.

2. The infant may be infected with TB, but it is premature to react until the older brother is confirmed to actually have active TB.

3. The infant most probably has had household contact with an active TB case – this is an urgent public health matter and the infant should receive a postro-anterior and lateral chest X- ray, physical exam, and TST as soon as possible.

4. The infant most probably has been exposed to active TB – schedule an appointment for a TST.

In regards to the infant brother, which is the most appropriate response by the local health department?

1. The infant is not symptomatic and in no immediate danger.

2. The infant may be infected with TB, but it is premature to react until the older brother is confirmed to actually have active TB.

3. The infant most probably has had household contact with an active TB case – this is an urgent public health matter and the infant should receive a postro-anterior and lateral chest X- ray, physical exam, and TST as soon as possible.

4. The infant most probably has been exposed to active TB – schedule an appointment for a TST.

Pediatric tuberculosis Age less than 5 years is one of the most important

factors in highlighting contacts. TB disease is more likely to disseminate in younger

children, the incubation period is shorter, and disease tends to be more severe with higher mortality rates (e.g. TB meningitis).

The CXR should be ordered at the same time as a TST. A TST can be falsely negative in young children < 6 months old so both postero-anterior (PA) and lateral CXRs are needed to exclude active disease.

Pediatric tuberculosis

Although a negative TST does not rule out active disease, a positive TST can be seen in children just a few months old and should be ordered.

Children may appear asymptomatic, have abnormal chest radiographs, and progress very quickly to more fatal forms of TB (e.g. TB meningitis). Therefore, a contact less than 5 years old is not considered fully evaluated until they receive a PA and lateral CXR and physical exam, as well as a TST

References

1.National guidelines on management of tuberculosis

in children, 2013

2.Guidance for national tuberculosis programmes on

the management of tuberculosis in children. Int J

Tuberc Lung Dis. 2006 Oct;10(10):1091-1097.

3.CDC, 2005