Childhood tuberculosis (Part-I). Epidemiology, pathogenesis, clinical profile.

PIP: This paper focuses on the pathogenesis and clinical profile of tuberculosis (TB), a bacterial infection caused by Mycobacterium tuberculosis characterized by granuloma formation in infected tissues and by cell-mediated hypersensitivity. TB remains a major cause of morbidity and mortality worldwide and is the most common cause of death from a single infectious disease, particularly in children. Nearly 40 million children are likely to be exposed to the risk of TB and nearly 3-4 million children below age 5 years are estimated to be infected and may progress to disease. TB accounts for 10-15% of all pediatric deaths in a number of Indian hospitals. Factors such as low socioeconomic status, infections, drugs such as steroids, and age predisposes a person to TB. Childhood TB is classified as follows: 1) asymptomatic mantoux positive, 2) symptomatic mantoux positive, 3) primary pulmonary complex, 4) progressive pulmonary disease, 5) disseminated TB, 6) cervical and abdominal TB, 7) tubercular meningitis, 8) progressive bacillus Calmette-Guerin (BCG) disease, and 9) congenital tuberculosis. Among the various symptom complexes of childhood TB are failure to gain weight or weight loss, sudden onset of fever with erythema nodosum and phlyctenular conjunctivitis, failure to gain weight with respiratory wheezing. The direct and indirect impact of HIV infection on the development of TB in children is also discussed.^ieng

Childhood tuberculosis (part-II) (diagnosis and management).

PIP: This article focuses on the diagnosis and management of childhood tuberculosis (TB). Diagnostic tests for childhood TB can be classified into five groups: 1) intradermal skin tests; 2) mycobacterial detection and isolation; 3) immune diagnosis; 4) nonspecific tests; and 5) radiologic investigation. Of the intradermal skin tests, the Mantoux test is the most accurate, definitive, and reliable. The three diagnostic scoring systems discussed in this article are 1) WHO Provisional Guidelines for Diagnosis of TB in Children, 2) Udanis Simple Scoring Technique Criteria, and c) Kenneth Jones Scoring. Moreover, TB has been classified into five groups based on clinical types to optimize treatment protocol. These groups are presented in the article together with the treatment indications.^ieng