Childhood TB: How is it different?

Diagnosis is often difficult.

1.   Firstly, the confirmatory ‘sputum test’ is often unavailable because:

a)   TB in children is primarily not in the lungs and is of a sputum negative variety; kids rarely emit germs and are non-infectious.

b)   Even otherwise, a small kid tends to swallow his spit; he simply can’t be expected to cough out a sputum sample.

2.   Secondly, a sick child may at times appear a-symptomatic (there are no symptoms or complaints at all).

Diagnosis is arrived at by diligently searching through a checklist of clues, each tick mark indicating ‘present’ adding weight to the possibility of TB:

1.      A family member of the child is known to have sputum positive TB.

2.      Failure of the child to grow as expected or he loses weight.

3.      Cough for over 3 weeks.

4.      Fever for over 3 weeks.

5.      Some other illness of long duration like:

a.      Palpable glands (often glued together in the form of a cluster) in the neck, underarms or groin etc.

b.      A persistent swelling over a bone or a joint.

c.      A deformity of backbone.

d.      A mass or fluid collection in the abdomen.

6.      Chest X-ray shows fluid (pleural effusion) or round shadows of glands.

7.      Tuberculin skin (Montoux) test is positive.

8.      The child is known to be HIV infected.

9.      BCG vaccine not given at birth (as confirmed by absence of BCG scar on left shoulder).

10.    A recent debilitating episode of whooping cough or measles etc., depleting the child’s immunity