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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Tuberculosis (TB)

TUBERCULOSIS (TB)

Though common in children from poorer homes, I have seen quite a few children with tuberculosis from the higher socioeconomic group. Fortunately, we now have excellent drugs available for the treatment and, if diagnosed early, the prognosis in most cases is excellent. 

SYMPTOMS: The following are the symptoms that should alert us to the possibility of the child having tuberculosis. But don’t jump to conclusions because similar symptoms can also be found in many other conditions.

  • Persistent unexplained fever, cough, loss of weight and appetite.
  • Enlarged glands in the neck or armpits or groin, which seem to get stuck to each other (not discrete and separate from each other). They may also get stuck to the overlying skin.
  • Pain in the chest with pleurisy (infection of the pleura covering the lungs), unexplained swelling of a bone or joint, and backache.
  • Persistent pain in the abdomen with diarrhoea or a swelling in the abdomen.
  • Persistent headache, vomiting, convulsions or disturbed consciousness.
  • Unresolved pneumonia or glands noticed in X-ray of the chest.
  • Contact with an adult having tuberculosis.

Tiny little palpable glands in the neck or elsewhere should not be confused with tuberculosis. They are often secondary to some local skin infection rather than tuberculosis, or due to diseases like chickenpox or lice in the head. Pain in the abdomen is mostly due to causes other than tuberculosis.

DIAGNOSIS: Confirmatory diagnosis can only be made by demonstrating the presence of TB germs. That is not always possible.

A Mantoux Test (Tuberculin test) is asked for. It should not be done with 10 TU or 100 TU as is sometimes ordered by some doctors. That may give false positive results. The test should be done with 5 TU. Some recommend it with 1 TU, but we find that with 5 TU, we are more likely to detect cases needing more careful follow-up or treatment.

A positive test does not necessarily mean that the child needs treatment for tuberculosis. We have to examine the patient in totality, including the presence or absence of a BCG scar, the symptoms, general condition, history of contact, and results of other tests including the X-ray of the chest, examination of pleural fluid in case of pleural effusion (collection of fluid between the coverings of the lungs), biopsy of the gland or bone, examination of cerebrospinal fluid (CSF) in case of suspected meningitis, etc.

The CSF is taken out by tapping the space between the two lower spinal vertebrae with a lumbar puncture needle.

In absence of other features, a child with a positive Mantoux Test of 10 mm. or more in the presence of a BCG scar is weighed on the same scale every month. If he remains fit and continues to gain weight, no treatment is given.

TREATMENT: Most cases of tuberculosis are now treated with 3 anti-tubercular drugs to begin with. One is given for 2 months and the other two for 6 months or more. One of these two is given on an empty stomach. Do not be surprised if it makes the child’s urine appear red; this is normal.

As these drugs can cause liver damage in a small number of patients, your doctor may keep an eye on your child’s liver functions as and when required.

Some children have only mild liver dysfunction, but others can develop jaundice and severe liver damage. In such cases, the doctor will make significant changes in the treatment.

For parents, the most important aspect of the treatment is to see that the treatment is not stopped prematurely.

After a month or two of treatment, children often look completely normal and some parents become lax about regular treatment. This can be hazardous. The organisms can develop resistance to the drugs and they may not remain as effective as before.


Management Of Contacts With A Case Of Tuberculosis
All the contacts must be subjected to a tuberculin test. Your doctor will then decide whether the child needs any further investigation or medication.

A newborn of a mother having active tuberculosis should be given BCG and kept apart from her as much as possible for about 3 months. The child is to be kept under close supervision by the doctor. Breastfeeding should be continued. If the disease was diagnosed during pregnancy or soon after delivery, your doctor may ask for a tuberculin test and a chest X-ray to rule out a congenital infection being present from birth.




7 March, 2016

 
Part 4
The A-Z of Childhood Illnesses

Abdominal Pain
Abrasions or Scratches
Acute Glomerulonephritis
Acute Nephritis
Acute Watery Diarrhoea
Addictions
Adenoids
AIDS
Allergies
Anaemia
Anorexia (Poor Appetite)
Asthma
ADHD
Autism
Backache
Bed-Wetting (Enuresis)
Birth Deformities
Bites and Stings
Bleeding
Bone, Joint and Muscle Injuries
Bowlegs and Knock-Knees
Breathlessness
Bronchiolitis
Burns
Calcium Deficiency
Cancer
Cardiac Pulmonary Resuscitation
Cerebral Palsy (CP)
Chickenpox
Choking
Circumcision
Cleft Lip and Palate
Common Cold
Congenital Heart Disease
Constipation
Convulsions or Fits or Seizures
Cough
Croup
Crying
Cuts
Dengue Fever
Diabetes Mellitus
Diarrhoea, Dysentery ...
Diphtheria
Down's Syndrome
Earache, Ear Infections ...
Electric Shock
Encephalitis
Eye Problems
Fears
Foot Problems
German Measles (Rubella)
Glands in the Neck ...
Headache
Head Injury
Hepatitis
Hydrocephalus
Hypertension
Hypospadias
Influenza (Flu)
Jaundice
Joint Disorders
Kala-Azar
Leptospirosis
Limp and Pain in the Legs
Malaria
Malnutrition (Undernutrition)
Measles
Meningitis
Meningomyelocele
Menstrual Problems
Mental Retardation (MR)
Mouth To Mouth Breathing
Mumps
Nephrotic Syndrome
Nose-Related Problems
Obesity
Pneumonia
Poisoning
Poliomyelitis
Premature Baby
Prolapse of the Rectum
Rabies
Rheumatic Fever
Rheumatoid Arthritis
Rickets
Short Child
Skin Conditions
Sleep and Sleep Problems
Sore Throat (Pharyngitis)
Splinters
Stammering
Stridor (Noisy Breathing)
Teething and Care of Teeth
Tetanus (Lock Jaw)
Thrush
Thumb-Sucking
Tics
Torticollis
Tracheoesophageal Fistula
Tropical Eosinophilia
Tuberculosis (TB)
Typhoid
Umbilical Problems
Undescended Testis
Urinary Infection
Vaginal Discharge
Vomiting
Wheezing
Whooping Cough (Pertusis)



Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Emergencies
Prayer And Your Child's Health
The Role of Nature Cure
Homoeopathy
Ayurveda and Child Care
Congenital Heart Disease FAQ
 
Guide to Child Care
Home
Introduction
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand
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