Chest Tuberculosis

What are the signs and symptoms of chest Tuberculosis in children?

  • Child who have persistent fever and cough for more than 2 weeks should be evaluated for tuberculosis.
  • Other associated features could be poor appetite, loss of weight and lymph nodes at any site of the body.
  • Contact with an adult with tuberculosis could be an additional pointer.

How do you diagnose Chest TB in children?

  • The diagnosis is based on the above signs and symptoms with the associated findings on Chest Xrays.
  • Chest Xray would in such cases show findings such as lymph nodes, pneumonia, cavities, miliary mottling etc.

What is the utility of a Mantoux test in diagnosis?

  • Tuberculin is an antigen which is injected into the skin on the voler aspect of the left forearm of the child.
  • The reaction of the body to the antigen is seen and read at 72 hours after injection. The induration or the swelling is read.
  • Reactions more than >10 mm is considered suggestive of tuberculosis Infection.
  • It needs to be remembered that all infected children do not have active tuberculosis and hence would not need treatment. The diagnosis of TB disease depends on other factors such as symptoms, chest xrays etc.

What are the tests which can confirm TB disease?

  • Confirmatory tests would need the TB bacteria to be demonstrated.
  • If the child is coughing and brining out sputum or phlegm then this would be subjected to testing like a smear examination, Xpert Rif and TB cultures.
  • Many children do not bring out sputum but tend to swallow them. In such cases we would offer testing of the gastric aspirates. This is a very simple procedure. The child would be called after overnight fasting. A soft tube is gently passed into the stomach and the gastric contents are aspirated. These are then sent for detailed testing.

What is the role of flexible bronchoscopy in diagnosis of TB in children?

  • Most children with TB would present with pneumonia which is not improving with the usual medicines.
  • In such cases flexible bronchoscopy is of immense help. We would be able to directly see any signs of TB in the airways. We would also be able to take a sample from the area involved and send for detailed examination to the laboratory.

Is all this detailed examination important or can we treat on symptoms and Xrays?

  • This testing is very important since it would help us confirm the disease and also let us know to which drugs the bacteria is sensitive.
  • Drug resistance is increasing in our country and hence it is important that in all cases samples are sent for detailed analysis to the lab.