Diagnosis

• Sputum for microscopy and culture

  • For children able to provide good quality sputum

• Gastric lavage (aspiration)

  • For children <8 years or those who are unable to produce sputum
  • Should fast for 4 hours prior to collection

• Gene Xpert

• Unequivocal hilar lymph node enlargement with or without lung parenchyma opacification

• Miliary mottling (especially in HIV non-infected host)

• Large pleural effusion (≥1/3 of pleural cavity) in children >5 years

• Apical opacification with cavitation (adult type disease; very rare in children, common in adolescents)

• Obtain tissue sample (biopsy/aspiration) if possible for AFB and Mycobacterial culture

  • e.g. pleural fluid, lymph node aspirate or biopsy

Diagnosis of EPTB

• Large pleural effusion (≥1/3 of pleural cavity) in children >5 years

• Pleural tab indicates lymphocyte rich exudates

• Clinical picture suggestive of TB

• Tuberculin skin test is useful in the diagnosis of TB infection in young children for contact tracing

• It is also useful as an adjunct test where the diagnosis of TB is uncertain

Results:

• Induration >10mm is considered positive, irrespective of whether BCG has been administered

• Induration >5mm is considered positive in HIV positive or malnourished children

• Negative TST does not rule out TB inc children

  • TST may be negative despite the child having TB, especially in severe disseminated TB, malnutrition, and HIV disease

IGRAs should not replace the tuberculin skin test (TST) in low- and middle-income countries for the diagnosis of latent TB infection or for the diagnostic work-up of children (irrespective of HIV status) suspected of TB disease in these settings

1. Miliary TB
2. Clinical signs suggestive of HIV disease
3. Known or suspected HIV positivity in mother or father
4. Relapse or treatment failure
5. Severe acute malnutrition