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.
