Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

Clinical Features

Note

Clinical presentation of tuberculosis in children is frequently non-specific

Investigate children for tuberculosis if they have risk factors or suspicious clinical features

Indications of Tuberculosis

Risk factors for developing childhood tuberculosis

  • Close contact (household, close relatives, caregiver, neighbour, and teachers) with a newly diagnosed smear-positive case or smear-negative culture positive case

  • Age <5 years

  • HIV infection

  • Severe malnutrition, measles, and immunosuppressive drugs or illnesses

  • Absence of BCG vaccination

  • Failure to thrive or weight loss (documented)

When to suspect TB in children

Suspect TB if ≥2 out of 3 following features are present:

  1. Fever (38ºC) for more than 2 weeks (After exclusion of common causes of fever such as malaria) and/or cough for more than 2 weeks (not improved after a full course of antibiotics)
  2. Failure to gain weight (weight loss if known/consult weight chart)
  3. History of contact with suspected or diagnosed TB patient

Signs Suggestive of Childhood TB

Pulmonary Tuberculosis

Persistent pneumonia after full course of appropriate antibiotics

Extra-pulmonary Tuberculosis (EPTB)

Highly suggestive:

  • Pleural effusion

  • Acute vertebral gibbus (upper vertebral kyphosis)

  • Non-painful glands with draining sinus

Suggestive:

  • Meningitis not responding to antibiotics

  • Pericardial effusion

  • Swollen non-painful joints

  • Significant enlargement of 2 or more lymph nodes

    • >2cm in diameter with no known local cause and not responding to antibiotics

  • Distended abdomen with ascites

  • Clinical features indicative of Tuberculin hypersensitivity

    • e.g. erythema nodosum, phylctenular conjunctivitis