Abstract

PIP: Tuberculosis (TB) causes 1-2 million deaths worldwide. In India almost 3.4 million children have TB; 40% of them contract TB by the age of 6 and 80% by the age of 16. Active TB can be developed even via casual contact, especially with sputum-positive cases, according to a study carried out in British Columbia and Saskatchewan, Canada. If a child also has measles or whooping cough, the risk of infection is greater from an adult with TB. Even children vaccinated with BCG can develop TB after reinfection. About 10-15% of children infected with the bacilli develop TB, and the same percentage of TB cases is infectious. Approximately 4-10% of child mortality is related to TB. Often diagnosis is based on indirect evidence, because the child with TB frequently has general ill health and fails to develop properly. Symptoms like cough may also be related to respiratory infections, viral infections, and asthma. Lymph enlargement has also been misdiagnosed as tubercular. Clinicians have tended to treat children with strongly positive tuberculin reaction, although it is merely an index of infection. Short-course chemotherapy in children has shown shortcomings; for example, partial clearance of pulmonary lesion as indicated by radiology or the need for extended therapy in children with lymph node TB. The correct use of isoniazid is still controversial (5 mg/kg vs. 10 mg/kg), although recent studies have shown that the lower dose is effective with fewer side effects. Drug resistance is on the rise in child TB cases; thus, treatment modalities need to be developed. Parental attitudes are the major limiting factor in completion of therapy. The National Tuberculosis Program emphasizes the treatment of sputum-positive cases to reduce transmission. The control of TB requires: study of prevalence in vulnerable populations; emphasis of TB in the medical curriculum; training programs; and IEC to identify barriers in parental attitudes.