16.1 Diagnosis and management of TB in children
In this section, you will learn how to diagnose and treat TB in children and how to follow their progress after treatment. The diagnosis is made at the health centre or hospital and children will be referred to you to continue treatment in the community under your supervision. The families of children who have TB may ask you questions regarding the drugs that their child is required to take, so it is very important to know a little about the major anti-TB drugs, even though you are not the key person involved in diagnosing TB and prescribing anti-TB drugs.
Note that sputum smear-negative, but culture positive patients are also infectious, but to a lesser degree
Very often children who are exposed to a positive contact within their close environment (especially the household), will acquire tuberculosis infection. A close contact is defined as someone living in the same household, or being in frequent contact with a person who is sputum smear-positive for TB. This exposure leads to the development of a primary (the first or original) lesion in the lungs, which is likely to spread to the regional lymph node(s). In the majority of cases, the child’s immunity will control the disease process at this stage. Progression to TB disease occurs more commonly in children under five years of age and in children who are HIV infected (because their immune systems are therefore compromised), or who have had measles, or who are malnourished.