Paediatric TB

Clinical description

The diagnosis of TB in children relies on thorough assessment of all the evidence derived from a careful history of exposure, clinical examination and relevant investigations. The recommended approach to diagnosing TB in children includes:

• Gathering a detailed patient history, including history of TB contacts, BCG status and

symptoms consistent with TB;

• Clinical examination including growth assessment;
• HIV testing: provider-initiated testing and counselling (PITC);
• Sputum microscopy, Gene Xpert and culture when possible.

The presence of any of the following strongly suggests a diagnosis of PTB:

• Current cough of any duration (productive or non-productive)
• Unexplained weight loss
• Failure to thrive and/or malnutrition
• History of close contact with a TB case within the past year
• Fever and/or night sweats

All children with symptoms suggestive of TB should be investigated. Children can present with TB at any age but it is most common in the under-5 age group and during adolescence.

The following symptoms are suggestive of TB meningitis, especially in young children with TB exposure:

• Decreased appetite, often with weight loss;
• Features of increased intracranial pressure such as vomiting without diarrhoea, early

morning headache, irritability;

• Drowsiness/lethargy and convulsions, especially focal seizures;
• Behavioural changes (irritability, confusion or agitation).

Key facts

• Children who are close contacts of an infectious TB case are at high risk of becoming

infected with MTB and developing active TB within two years of exposure.

• Clinicians should have a high index of suspicion for investigating TB and commencing

young children on TB treatment.

• Once an adult contact is confirmed as having TB, the main clinical decision is whether the

child needs full TB treatment or isoniazid preventive therapy (IPT) chemoprophylaxis National Tuberculosis Control Programme 43 Key risk factors for TB in children

• Household or other close contact with a case of PTB (especially smear-positive or

culture-positive PTB)

• Age less than 5 years
• HIV infection
• Severe malnutrition