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.

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.