The Clinical Presentation of Tuberculous Disease in Children

Department of Pediatric Dentistry
Lutheran Medical Center
Date: 05/14/2009
Article title: The Clinical Presentation of Tuberculous Disease in Children
Author(s): Waagner, DC
Journal: Pediatric Annals
Volume (number): vol 22:10
Month, Year: 1993
Major topic: Tuberculous
Minor topics: N/A
Type of Article: Review

Main Purpose: Review the differing presentations of tuberculous disease seen in children.

Overview of method of research: Not research, per se, rather a textbook style review. Perhaps a review of literature.

Findings:
In 1993, tuberculosis was on the rise. It must always be accounted for in the differential diagnosis of children with pulmonary infection. It should also always be considered when children present with persistent fever, wight loss, malaise, or failure to thrive.

Key points/Summary :
Early diagnosis is key to start therapy before the disease process begins.
Many patients remain asymptomatic in the early stages of the disease and are only diagnosed through a positive skin hypersensitivity test.
Even if asymptomatic, early chemotherapy and contact investigations should be initiated before disease progresses.
Endothoracic lymphadenopathy and endobronchial disease: chest xray shows collapse-consolidation lesions (segmental fan-shaped opacification)
Progressive primary pulmonary tuberculosis: a pulmonary focus enlarges into a caseous mass, children are usually very ill. Frequently moist rales are heard over the infected area.
Chronic pulmonary tuberculosis: uncommon in kids (mostly seen in adults) kids have cachectic appearance, supraclavicular adenopathy and moist rales ausculated over the pulmonary apical areas.
Pleural effusion: 8% of children, symptoms of fever, cough and weight loss, followed by acute onset of chest pain and shortness of breath. Fever is elevated for 1-2weeks and drops in the 3rd.

Extrapumonary tuberculosis
Miliary tuberculosis: most severe hematogenous tb. Infants are at highest risk. Symptoms vary but child is usually acutely ill and choroidal tubercles can be seen on ophthalmic exam in 13-87% of patients.
Tuberculous meningitis: most grave complication. Usually occurs over 3 weeks. Most patients exhibit resistance to neck flexion and may have bulging anterior fontanelle.
Superficial tuberculous lymphadenitis:most common extrapulmonary tb. Early complication occuring within 6 months of infection.
Skeletal tuberculosis: can be a complication of the primary infection, but may not manifest until 2-3 years afterward.
Most chronic pulmonary cases occur in children acquiring the primary infection after age 7.

Assessment of article: Great review, especially in light of our recent scares in the clinic