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PRACTICE GUIDELINES
Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 106-113

Diagnosing pulmonary tuberculosis in children


Pediatric Infectious Diseases, Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Valsan Philip Verghese
Department of Child Health, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_17_17

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Children account for about 5% of new TB cases in India but this may be an underestimate, as clinical signs of TB are subtle in children. Pulmonary TB is the most common form in children but diagnosis is challenging due to various factors including difficulty in collecting specimens from young children who tend to swallow sputum and produce fewer TB bacilli in specimens compared to adults. Tests such as the AFB smear used in adults are therefore often negative in children. A high index of suspicion needs to be maintained in order to make the diagnosis. Symptoms such as persistent fever and non-remitting cough are highly specific for a diagnosis of TB. The chest radiograph is the most important investigation for making an early diagnosis of in pediatric pulmonary TB. When starting empiric anti-tuberculous therapy in children, it is essential to monitor the treatment response in the form of resolution of symptoms and gain in weight. A poor clinical response to treatment should alert one to the possibility of poor adherence to therapy, incorrect doses of antituberculous drugs, presence of TB resistant to first-line drugs or an incorrect diagnosis of tuberculosis in the first place.


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