Pediatric Tuberculosis: A Review of Evidence-Based Best Practices for Clinicians and Health Care Providers

Abstract

Advances in pediatric TB care are promising, the result of decades of advocacy, operational and clinical trials research, and political will by national and local TB programs in high-burden countries. However, implementation challenges remain in linking policy to practice and scaling up innovations for prevention, diagnosis, and treatment of TB in children, especially in resource-limited settings. There is both need and opportunity to strengthen clinician confidence in making a TB diagnosis and managing the various manifestations of TB in children, which can facilitate the translation of evidence to action and expand access to new tools and strategies to address TB in this population. This review aims to summarize existing guidance and best practices for clinicians and health care providers in low-resource, TB-endemic settings and identify resources with more detailed and actionable information for decision-making along the clinical cascade to prevent, find, and cure TB in children.

Keywords: infectious disease; pediatric; tuberculosis.

Figure 1

The WHO algorithm for screening for and evaluation of TBI and TPT eligibility in children from the WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents [39].

Figure 2

Typical clinical features of EPTB and suggested investigations, from ‘Diagnosis And Management of Tuberculosis In Children And Adolescents: A Desk Guide For Primary Health Care Workers’ [93]. * Typical findings: straw coloured fluid, exudate with lymphocytic predominance and high protein; sample could be sent for rapid molecular diagnostic testing and culture. † Referral may be necessary for investigation and laboratory support, as well as clinical care. If all options for referral have been explored and referral is not possible, start TB treatment. If TB meningitis is suspected, start TB treatment immediately with recommended regimen for TB meningitis.

Figure 3

Common chest X-ray findings organized by disease severity, from the Union Diagnostic Chest X-Ray Atlas for TB in Children [97].

Figure 4

(A). The WHO-recommended integrated treatment decision algorithm for use in settings with access to CXR, from the WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents; (B). The WHO-recommended integrated treatment decision algorithm for use in settings without access to CXR from the WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents [39].