- Symptoms are often non-specific, particularly in young children and often mimics common childhood illness.
- Childhood TB is paucibacillary & a microbiological diagnosis is often not possible.
- It is difficult to obtain sputum or other respiratory specimen for bacteriological confirmation.
- The Tuberculin Skin Test (TST or Mantoux Test) is often negative in malnourished children or in children with overwhelming TB. Moreover, a positive MT cannot differentiate active TB disease from infection.
- CXRs are often non-specific and prone to variable interpretation.
8.4 Diagnosis of tuberculosis in children
exp date isn't null, but text field is
Diagnosis of TB in children is difficult as symptoms are often non-specific, most children cannot produce sputum for microscopy/geneXpert examination, X-rays are often non-specific and the Mantoux test is often negative in children with severe malnutrition. Establishing the diagnosis in children requires careful and thorough assessment of all the information derived from careful history taking, clinical signs and symptoms and relevant investigations like Mantoux test (TST), chest X-ray (CXR), smear microscopy, geneXpert and other investigations.
PTB is a common form of TB in children although bacteriological confirmation may not always be possible for young children. In this group, sputum induction and gastric aspiration have been documented to be an effective method for collection of specimens. Every attempt to collect sputum should be made whenever possible. Sputum sample collection is strongly encouraged for the children who are able to produce a sputum sample.
- Careful history taking (including history of contact with TB and symptoms suggestive of TB)
- Clinical assessment (including serial weight monitoring/growth assessment)
- Investigations
- Mantoux test
- Chest X-ray and other radiological evaluation
- Bacteriological confirmation whenever possible: Smear microscopy, Xpert-MTB RIF, Culture of respiratory sample / gastric lavage
- Other supportive investigations relevant to suspected PTB/EPTB
- HIV testing