True about Tuberculosis in children-

Ans. is 'd'i.e., All of above Tuberculosis in children y Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, y Cases of tuberculosis represent 5-15 percent of all tubercular cases. Clinical manifestations of TB in children y The majority of children with tuberculosis infection develop no signs or symptoms at any level. y Occasionally, infection is marked by low-grade fever, mild cough, malaise and flu-like symptoms. A) Primary pulmonary disease The lung is the portal of entry in > 98% of cases. The primary complex of tuberculosis includes local infection at the portal of entry and regional lymph nodes that drain the area. The combination of the parenchymal pulmonary'- lesion and corresponding lymph node is called Ghon complex. Asymptomatic pleural effusion is so frequent in primary- tuberculosis that it is basically a component of the primary complex. - Nelson It may have one of the following course : - Heating by fibrosis and calcification. Progressive primary> tuberculosis. Cavity' Obstructive emphycema y If incomplete obstruction is caused by lymph nodes. Resorption atelectesis y If complete obstruction is caused by lymph nodes. Tubercular bronchits & brionchiactasis Hematogenous dissemination During early bacteremia seeding may occur at apex Simon's focus. Miliary tuberculosis Collapse consolidation (segmental lesion) A combination of pneumonitis and atelectasis. B) Chronic pulmonary tuberculosis #Infrequent in young children # Children above the age of seven years, especially girls are more vulnerable. #Commonest site of chronic pulmonary tuberculosis is the apex of lung Puhl's lesion. #Infraclavicular lesion of chronic pulmonary tuberculosis is called Assman's focus. #Regional lymph nodes are not involved in chronic pulmonary TB (in contrast to primary TB). Lab investigations of pediatric TB o ESR and blood counts : No value in diagnosis or follow up of TB. o Demonstration of AFB : o Children don't expectorate out sputum, but swallow it. Therefore sputum is not available for examination. o A laryngeal swab may be obtained for smear and culture examination for mycobacteria o It is customer}' to examine the gastric lavage in children for bacteriological examination on 3 consecutive days, o Aspiration of early morning gastric contents (before breakfast) is done with a ryle's tube and sent for bacteriological examination. Adding vancomycin to the sample improves the yield of mycobacterium. o The CSF, Pleural fluid or bronchial aspirate, urine and discharges from tuberculous sinuses are examined for tubercle bacilli. o Histopathology : Material for histopathology may be obtained by biopsy or FNAC. o PCR : High sensitivity and specificity for pleural fluid and low for gastric aspirate, o CXR and CT may show characterstic features. o USG may be helpful for detection of enlarged abdominal lymph nodes, o Serology : Elisa or other methods have no utility in pediatric TB. Antitubercular drugs used in children # First line drugs : Isoniazid, Rifampicin, EthambutoL Streptomycin, Pyrazinamide #Second line drugs : Cycloserine, Ethionamide, PAS, Capreomycin, Kanamycin #Other drugs. Quinolones Ofloxacin, Rifamycin, Amikacin, Imipenem, Ampicillin