16.1.2 Signs of childhood TB
The clinical picture of pulmonary TB in older children is similar to that of pulmonary tuberculosis in the adult. For older children capable of producing sputum, samples should be collected as for adults. A range of additional physical signs are suggestive of EPTB. These can include swelling over the spine (called a gibbus) and/or an enlargement of the side of the neck, and neck rigidity not responding to treatment with antibiotics. Other signs are abdominal swelling and non-painful enlarged joints. If a child has the symptoms of pulmonary or extra-pulmonary TB, you should refer him or her for investigation.
You should always ask adult TB suspects and patients if there are children in their households. Any child suspected of having TB should be referred for investigation.
The diagnosis of TB in younger children (less than a year of age) can be more difficult. One of the indictors that you should be aware of is contact with a family member or close associate with TB. Another key factor in diagnosis is loss of weight and failure to thrive. One of the problems is that children of this age rarely produce sputum and, as you know, this laboratory test is the main method of diagnosis in adults.
In those cases of younger children where you suspect TB, you must tell the family to take the child to a higher health facility for diagnosis. To make the diagnosis of childhood TB with a fair degree of accuracy, one or more of the tests outlined in Box 16.1 are generally followed.
Box 16.1 Recommended approach for diagnosing TB in children
- Careful history-taking, including history of TB contacts and symptoms consistent with TB
- Clinical examination, including growth assessment; where you see failure to grow, especially in younger children, and weight loss, suspect TB and send the child for investigation
- Sputum examination; children able to produce sputum should submit sputum for examination
- Chest X-ray; this investigation is relevant for suspected pulmonary TB cases not producing sputum and for extra-pulmonary TB
- Biopsy for extra-pulmonary TB; this procedure was mentioned in Study Session 14
- HIV testing; where appropriate, advise the parents of a child TB suspect to agree to an HIV test for the whole family.
16.1.1 Symptoms of childhood TB
16.1.3 Diagnosis of tuberculosis in HIV-positive children