Pediatric Tuberculosis

Andrea T. Cruz; Jeffrey R. Starke

doi:10.1542/pir.31-1-13

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Andrea T. Cruz, MD*
Jeffrey R. Starke, MD*

^*Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Tex

Objectives

After completing this article, readers should be able to:

Discuss how the risk of disease, clinical presentation, and morbidity of tuberculosis (TB) vary by age and immune status.
Delineate the epidemiologic risk factors for the acquisition of TB infection, the subsequent development of TB disease in a minority of children, and the risk of multidrug-resistant TB.
Describe the presenting signs and symptoms of TB in children.
Recognize the extrapulmonary manifestations of TB and which children are at risk for these forms of disease.
Explain the utility of the tuberculin skin test, potential false-positive and false-negative results, and the effect of the bacillus Calmette-Guérin vaccine on the ability to interpret the test.
Discuss interferon-gamma release assays and their limitations.
List the primary findings seen on chest radiography in the child who has pulmonary TB.
Plan a therapeutic course for children who experience TB exposure, infection, and disease.
Describe the measures that can be taken to prevent the development of disease and to limit spread of TB within the community and the health-care setting.

Introduction

Tuberculosis (TB) is an ancient disease, with evidence of skeletal TB found in mummies in both the Old and New World. The causative agent is Mycobacterium tuberculosis, a fastidious, aerobic, acid-fast bacillus. In the wake of human immunodeficiency virus (HIV) infection, the number of children and adults afflicted with TB has escalated tremendously worldwide in the past 25 years. Control of TB in children often has been neglected because children are ineffective transmitters of the bacillus and frequently escape the attention of TB control programs. However, much of the morbidity and mortality of TB occurs in childhood, and acquisition of TB infection during childhood contributes to the future reservoir of cases. Risk factor-based screening of children for TB infection, appropriate implementation of chemoprophylaxis, and a high degree …