Tuberculosis in Children

It is estimated that 1 3 rd of the world’s population is infected with Mycobacterium tuberculosis
Each year, about 9 million people develop TB, of whom about 1 5 million die
WHO has estimated that around 10 of global tuberculosis case load occurs in children( 0 14 years) of these childhood cases, 75 occur annually in 22 high burden countries that together account for 80 of the world’s estimated incident cases.

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Mr. Ravi Rai Dangi
Assistant Professor
Tuberculosis in Children
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Outlines
•Introduction
•Riskfactors
•Pathophysiology
•Clinicalsignandsymptoms
•Diagnosticinvestigation
•Management
•Exercise
•Learningoutcome
•References
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Introduction
•Itisestimatedthat1/3
rd
oftheworld’spopulationisinfectedwith
Mycobacteriumtuberculosis.
•Eachyear,about9millionpeopledevelopTB,ofwhomabout1.5
milliondie.
•WHOhasestimatedthataround10%ofglobaltuberculosiscaseload
occursinchildren(0-14years)ofthesechildhoodcases,75%occur
annuallyin22high-burdencountriesthattogetheraccountfor80%of
theworld’sestimatedincidentcases.

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•ChildrencanpresentwithTBatanyage,butthemajorityofcases
presentbetween1-4years.
•Diseaseusuallydevelopswithin1yearofinfection–theyounger,the
earlierandthemoredisseminated.

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•Householdcontactwithanewlydiagnosedsmear-positivecase
•Agelessthan5years
•HIVinfection
•Severemalnutrition.
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Etiology & Risk factors

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•Themostcommonagentassociatedwithpulmonaryandmostofthe
extra-pulmonarytuberculosisisMycobacteriumtuberculosis
Othersinclude
•M.Africanum
•M.Canetti
•M.Bovis
•M.Microti
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Causative agent

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•Isthroughinhalationofdropletsofinfectedsecretions.
•Persontopersonbyair-bornmucusdropletnucleiparticles1-5µmin
diameterthatcontainm.Tuberculosis.
•Environmentalfactorssuchaspoorcirculationenhancetransmission.
•Youngchildrenrarelyinfectotherchildrenoradults.
Mode of Transmission

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•Infectionisspreadbythetuberculosispatient,whodischargestuberclebacilli
inhissputumornasopharyngealsecretions.
•Inneonates,fewinfectionsmayalsospreadbythetransplacentalroute
(congenitaltuberculosis).
Reservoir of Infection

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•lungs–pulmonarytuberculosis
Extrapulmonarysites:-
•Meninges–tuberculousmeningitis
•Kidneys–renaltuberculosis
•Bones–osteomyelitis
•Fallopiantube–salpingitis
•Lymphnodes–cervicalregion(lymphadenitis)
Sites Affected

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(Initial infection or primary infection)
Entry of micro organism through droplet nuclei
Bacteria is transmitted to alveoli through airways
Deposition and multiplication of bacteria
Bacilli are also transported to other parts
Pathophysiology

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Phagocytosis by neutrophils and Macrophages
Accumulation of exudate in alveoli
New tissue masses of live and dead bacilli are surrounded by macrophages
which form a protective mass around granulomas
Granulomas then transforms to fibrous tissue mass and central portion of
which is called Ghontubercle
Pathophysiology

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Ghontubercle becomes calcified and becomes Collagenous scar
Bacteria become dormant and no further progression of active disease
(Active disease or re infection)
Inadequate immune response
Activation of dormant bacteria
Infected lung become inflamed Further development of pneumonia and
tubercle
Tuberculosis Occur
Pathophysiology

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•Pulmonary and extra pulmonary TB in pregnant women is associated
with increased risk of prematurity , growth retardation, LBW and
perinatal mortality.
•Congenital TB is rare because TB of female genital tract results in
infertility.
•Most common route of infection for the neonate is postnatal airborne
transmission from an adult with infectious pulmonary TB.
Tuberculosis in Pregnancy and newborn

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Clinical Manifestation
•Mildfever
•Malaise
•Anorexia
•Weightloss
•Failuretothrive
•Decreasedactivity
•Fatigue
•Coughisinconsistentsymptom
•Irritatingdrycough–symptomofbronchialandtrachealcompression

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Diagnosis of TB in children
•Carefulhistory(includinghistoryofTBcontactandsymptoms
consistentwithTB)
•Clinicalexamination(includinggrowthassessment)
•Tuberculinskintesting
•Bacteriologicalconfirmationwheneverpossible
•Investigationsrelevantforsuspectedpulmonary
•TBandsuspectedextrapulmonaryTB
•HIVtesting(inhighHIVprevalenceareas)

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•PULMONARYTBistreatedprimarilywithanttuberculosisagentsfor6
to12months.
•Pharmacologicalmanagement
Firstlineanttubercularmedications
•Streptomycin15mg/kg
•Isoniazid5mg/kg(300mgmaxperday)
•Rifampin10mg/kg
•Pyrazinamide15–30mg/kg
•Ethambutol15-25mg/kgdailyfor8weeksandcontinuingforupto4to
7months
Management

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Secondlinemedications
•Capreomycin12-15mg/kg
•Ethionamide15mg/kg
•Paraaminosalycilatesodium200-300mg/kg
•Cycloserine15mg/kg
•Vitaminb(pyridoxine)
Medical Management

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•Assessment
•ObtainhistoryofexposuretoTB
•Assessforsymptomsofactivedisease
•Auscultatelungsforcrackles
•Duringdrugtherapyassessforliverfunction
Nursing Management

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•Administerandteachselfadministrationofmedicationsordered
•Encouragerestandavoidanceofexertion
•Monitorbreathsoundsrespiratoryrates,sputumproductionand
dyspnea
•Providesupplementaloxygenasordered
•Encourageincreasedfluidintake
•Instructaboutbestpositiontofacilitatedrainage
Nursing Management

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•BewarethatTBistransmittedbyrespiratorydroplets
•Usehighefficiencyparticulatemasksforhighriskproceduresincluding
endoscopy
•Educatepatienttocontrolthespreadofinfectionbycoveringmouth
andnosewhilecoughingandsneezing
•Isolationofpatient
•Instructaboutriskofdrugresistanceifdrugregimenisnotstrictlyand
continuouslyfollowed
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Nursing management:

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•Carefullymonitorvitalsignsandobservefortemperaturechanges
•Explaintheimportanceofeatingnutritiousdiettopromotehealing
anddefenseagainstinfection
•Providesmallfrequentmeals
•Monitorweightofthepatient
•Administervitaminsupplementsasordered
Nursing management:

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•EducatepatientaboutetiologytransmissionandeffectsofTB
•Reviewadverseeffectsofdrugtherapy
•Participateinobservationofmedicinetaking,weeklypillcountsor
programmesdesignedtoincreasecompliancewiththetreatmentfor
TB
•ExplainthatTBisacommunicablediseaseandthattaking
medicationsismosteffectivewayofpreventingtransmission
•Instructaboutmedicationsscheduleandsideeffects
Nursing management:

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•ISOLATION
•Ventilatetheroom
•Coverthemouth
•Wearmask
•Finishentirecourseofmedication
•vaccinations
Prevention

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