Tuberculosis in Infants and Children

Abstract

One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.

FIGURE 1

Tuberculosis (TB) case rates by age group for children, 1993 to 2015. (Data in the public domain, courtesy of the CDC.)

FIGURE 2

Early collapse-consolidation lesion in a child with tuberculosis. Mediastinal adenopathy also is present on the right side.

FIGURE 3

Slightly more extensive right-sided adenopathy with atelectasis in a 2-year-old with tuberculosis.

FIGURE 4

Well-formed collapse-consolidation lesion on the right, with large mediastinal and hilar adenopathy and atelectasis.

FIGURE 5

Tuberculous pneumonia with bowing of the horizontal fissure. Children with this finding may have an associated bacterial infection.

FIGURE 6

Reactivation-type tuberculosis in an adolescent boy.

FIGURE 7

A tuberculous pleural effusion in an adolescent girl.

FIGURE 8

Miliary tuberculosis in an infant. The child presented with fever and respiratory distress.

FIGURE 9

Magnetic resonance imaging showing abnormal enhancement along the basilar cisterns, acute ischemia or possibly cerebritis involving the right caudate head, right putaminal and possibly right globus pallidus, ventriculomegaly (ventriculoperitoneal shunt in place), and enhancement along multiple cranial nerves.

FIGURE 10

A helpful technique for applying the Mantoux TST on a child. The hand is anchored on the side of the child’s arm, providing stability. The tuberculin is injected in a lateral direction.

FIGURE 11

An algorithm for the use of the TST and IGRAs in children. Entry into the algorithm assumes that the child has at least 1 risk factor for TB infection. Note: many experts use age <2 years as the starting point. Reprinted from reference , with permission from the American Academy of Pediatrics Committee on Infectious Diseases.