Tuberculosis in Children – Symptoms, Treatment and Remedies by Dr. Srikanta J T

The bacteria responsible for causing tuberculosis is known as Mycobacterium tuberculosis or M. tuberculosis. This bacteria travels and spreads through the air. If your child is in the same room as someone (Contact) who has the tuberculosis infection and happens to inhale the droplets that the infected person spreads through coughing or sneezing, the chances are that your child can catch TB too. In most cases, it is difficult to trace or know the primary contact. In this context, it is also essential to understand that many people, both children and adults, tend to carry a dormant form of M. tuberculosis in their bodies. But this presence itself doesn’t cause TB. When the child or adult’s immune system is down or the body has lost its ability to fight diseases, this gives the ideal environment for the bacteria to wake up and cause tuberculosis.

The different types of extrapulmonary tuberculosis include:

• Parenchymal TB (Lung)
• Mediastinal TB
• Pleural TB
• Endobronchial TB
• TB meningitis affecting the central nervous system
• Abdominal TB affecting the intestines, liver, and spleen
• Urogenital TB affecting kidney and bladder
• Tb affecting the musculoskeletal system which includes the bones and joints

[Read : Meningitis In Children]

Progression of Tuberculosis in Children

As we mentioned earlier, tuberculosis occurs due to air-borne bacteria and the disease is highly contagious. For easy understanding, the progression of this disease can be broken into three stages.

1. Exposure

When a child breathes air-borne tuberculosis bacteria, the bacteria find their way through the nose into the lungs and enter the lungs.

2. Latent Stage

In some cases, the body’s immune system fights the bacteria, and the disease remains in a dormant stage. This is known as primary tuberculosis. Some children can recover from this primary TB without showing symptoms or evidence of the disease.

3. Active Stage

There comes a stage when the immune system is no longer able to suppress the multiplication of the bacteria. At this point, the bacteria reactivates and the child will officially contract the disease. Some weeks can pass before the reactivation of the bacteria and the appearance of the symptoms post-exposure. Once these symptoms start showing, it becomes pertinent to take the child to the doctor for consultation and run the necessary tests so that timely treatment can be provided.

Parents must remember that pediatric tuberculosis is a curable disease and taking the child to the doctor at the earliest onset of symptoms will prevent further damage and kick-start the healing process.

Pulmonary Tuberculosis in Children

We know that the lungs are the first organ of the body to be affected by tuberculosis since the bacteria find an easy entryway through the nose via the breathing process. Once the bacterium gets the chance to get active, it quickly takes advantage of favourable temperature and atmosphere and starts multiplying. At this stage, it slowly starts penetrating the different parts of the lungs, causing different conditions, which we will explain a little further in this article.

Symptoms of Pulmonary Tuberculosis

• The earliest symptoms of pediatric tuberculosis include mild coughing accompanied by a low-grade fever.
• In some cases, the child may suddenly develop a cough, fever, and flu-like symptoms that can sometimes subside within a week or have intermittent symptoms for weeks.
• Some school-going kids do not show any symptoms (silent TB) or can show symptoms such as dry cough (with no phlegm), mild breathlessness, lack of appetite, and fever with night sweats.
• Younger kids can also start losing weight, may not show proper growth, and can experience stunted growth if the condition isn’t treated on time.

To sum up, the symptoms you should look for to suspect TB in your child include:

Primary Symptoms

• Dry cough (that seems to continue for a period of 3 weeks)
• Mild dyspnea or breathing difficulty or gasping for air
• Pain in the chest area
• Coughing blood (in severe cases)
• Low-grade fever
• Night sweats or chills

Additional Symptoms

• Lack of appetite
• Weight loss
• Nausea and vomiting
• Lethargy

Manifestation of Tuberculosis in Children

We earlier discussed that TB bacteria, once they enter the lungs, can affect different parts of the lungs and the body as well. Lymph nodes most commonly get affected due to tuberculosis. Let us take a look at the types of manifestations of pediatric tuberculosis.

1. Tuberculous Lymphadenopathy

Generally speaking, lymphadenopathy is a disease of the lymph nodes where the lymph nodes become of abnormal size and consistency. So, what exactly is a lymph node? A lymph node is a small bean-shaped structure and is an integral part of your body’s immune system. Lymph nodes play a vital role in filtering the blood that travels through the lymphatic system. Lymphatic fluids carry white blood cells that help fight disease and infections.

When TB bacteria affect the lymph nodes, they can cause the nodes to enlarge, resulting in diseased lymph nodes. This condition is called tuberculous lymphadenopathy. In some cases, the lung nodules get infected due to the presence of TB bacteria, resulting in scarring, known as a granuloma. In all these cases, lymph nodes stop functioning well, consequently reducing immunity.

Common symptoms of tuberculous lymphadenopathy include

• Fever
• Swelling of lymph nodes
• Dry cough
• Pain in the chest
• Loss of appetite
• Loss of weight

2. Mediastinal Lymphadenopathy

The term mediastinal lymphadenopathy refers to the enlargement of lymph nodes present in the mediastinum. The mediastinum is the area present between the lungs and houses your lymph nodes, thymus glands, trachea, cardiac nerves, etc.

When the lymph nodes present in the mediastinum get enlarged due to tuberculosis infection, it results in a condition called tuberculosis mediastinal lymphadenopathy. The chances of contracting this condition are higher in kids; while age advances, the risk goes down. For this reason, the occurrence of mediastinal tuberculosis is quite rare in adults.

In children, tuberculosis and in most cases, pulmonary tuberculosis is the major cause of mediastinal lymphadenopathy. The tuberculosis bacteria that enters the lungs passes through pulmonary lymph channels and enters mediastinal lymph nodes, causing inflammation.

Common symptoms of Mediastinal Lymphadenopathy associated with TB include

• Fever and night sweats
• Dry coughing
• Shortness of breath and difficulty breathing
• Weight loss
• Chest pain

3. Pleural Effusion

Pleural effusion can account for up to 20% of tuberculosis cases in children. A pleura is a thin tissue layer that forms a covering over the lungs and lines the chest cavity’s interior walls. Tuberculosis can sometimes result in fluid accumulation in the pleural space ( the space between the lung lining and the lung tissue). This fluid accumulation is known as pleural effusion, as a result of which the lungs which are normally soft like a sponge turn hard and lose their sponge-like consistency.

Some of the symptoms of TB Pleural Effusion include

• Dry cough (with no sputum)
• Chest pain
• Difficulty breathing/gasping for breath
• Inability to breathe in lying down position or Orthopnea

[Read : Breathing Problems In Children]

Causes of Tuberculosis in Children

Tuberculosis in children mainly spreads through the air when the child breathes the air that contains TB bacteria. A single exposure usually may not cause the disease unless the child has a low immune system. TB can occur after multiple exposures or when a latent or inactive TB bacteria turns active under specific conditions such as low immunity.

Which Child is at a Higher Risk of Getting Tuberculosis?

Now that we know how tuberculosis occurs and spreads, let us also try to understand if there is a specific set of children that are more prone to contracting TB than the others. The following group of children may have higher chances of getting TB.

• Children growing in developing countries are at a higher risk due to lower sanitary conditions, overcrowding, and low nutrition levels.
• Children growing in the same household as other TB patients are also at a higher risk of getting TB.
• Kids younger than four years of age and those nearing puberty age.
• Children suffering from autoimmune diseases or conditions, diseases such as HIV, or children going through immunosuppressive therapies or drugs.

Diagnosis of Tuberculosis in Children

A child who shows the classic symptoms of TB will be taken to a doctor who will analyse the symptoms, understand the current living conditions, possible exposure and the health history of the child and the family. After this, the doctor may prescribe one or more of the following tests.

Traditional Diagnostic Methods For Diagnosing Tuberculosis in Children

The conventional tests that doctors routinely use to find out if your child has tuberculosis include:

1. TB Skin Test

The TB skin test is also known as the Mantoux tuberculin skin test or Mantoux test for short. This test will require two visits to the lab. On the first visit, the technician will inject a small quantity of fluid into the skin of your child’s lower part of the arm and mark the injection site with a marker pen. You must take your child back to the lab after 48 to 72 hours. Depending on the inflammation at the test site, the technician may suggest the possibility of TB infection.

2. TB Blood Test

The blood tests to evaluate a patient for TB are called Interferon Gamma Release Assays or IGRAs. These blood tests quickly help identify the presence of TB bacterial infection in your child. If a child fails a skin test but still seems to show TB symptoms, the doctor may prescribe a TB blood test.

3. Chest X-Ray

X-rays are one of the traditionally used methods to diagnose TB. The technician will look for the presence of nodules, fluid formation, or anything unusual when taking the X-ray. Your child’s doctor may co-relate the finding of the X-ray with other tests and symptoms before making a final diagnosis and starting the child on treatments.

4. Sputum Testing

Rapid sputum tests are prescribed by doctors when other tests remain inconclusive. Sputum culture is routinely used by doctors and looks for the presence of TB bacteria in the sputum to confirm TB infection.

5. Biopsy of Abnormal Glands

In cases of extrapulmonary tuberculosis, a biopsy is used to confirm the presence of infection. The doctor or technician will draw tissue or fluid samples from the suspected TB site which will then be sent for evaluation.

The conventional testing methods, while effective to a certain extent, may not always give confirmatory results. These tests do not focus too much on the microbiology part and may not help the doctors in identifying which antibiotic the specific bacteria may be resistant to.

Keeping this in mind, the National Tuberculosis Eradication Programme (NTEP) 2021 has brought in new guidelines with advanced testing methodologies that can help in easier and quicker diagnosis and suggest the best treatment options.

Modern Diagnostic Methods to Detect Tuberculosis in Children

Modern diagnostic methods move away from conventional smear microscopy to the highly sensitive molecular methods of diagnosis. Let us look at some of the NTEP-approved tests that can yield better results and quicker diagnoses.

1. NAAT Tests

Rapid Nucleic Acid Amplification Tests or NAATs have a higher sensitivity and a quicker turnaround time. In most cases, they indicate drug resistance, too, giving the doctors timely information so that they can choose alternative medications without wasting time.

2. Gene-Xpert

The Gene-Xpert test, also called the Xpert-RIF/MTB Assay, is considered the gold standard in tuberculosis testing at early stages where other testing methods yield negative results. On the other hand, this test also helps detect rifampicin drug resistance at early stages. Gene-Xpert is a cartridge-based NAAT or CBNAAT and is gaining wide acceptance as the best available test for the early detection of tuberculosis.

3. Line Probe Assays (LPA)

The NTEP 2021 also recommends Line Probe Assays for early detection and multi-drug resistance identification. This test includes multiple NAAT tests that check for resistance to rifampicin and isoniazid, and also second-level medications and injections.

NTEP has also come up with a strategy named U-DST under which it makes it mandatory for every patient to undergo NAAT testing to help identify possible drug resistance. The key is to check old cases as well as fresh cases for drug resistance and provide alternative drug options for quicker recovery and prevention of infection recurrences.

Treatment of Tuberculosis in Children

The National Tuberculosis Eradication Programme, or NTEP, has introduced a daily treatment regimen specific to kids where kids will be given dispersible tablets in fixed dose combinations. Your child’s doctor will prescribe the correct dosages depending on age, weight, and other factors. Your doctor may also recommend pyridoxine supplementation to prevent long-term side effects from the drugs.

Home Care For Children Infected With Tuberculosis

Children need a lot of care in their recovery process. While timely detection and doctor consultation are the key to recovery, proper medication and home care will help quicken this process. Let us go through a few essential aspects when caring for your child with TB at home.

1. Medication

It is vital that your child takes the medication at the exact prescribed times and at the same timings every day. This will ensure that the medications work effectively. Missed doses can lead to drug resistance which can be quite serious later. Set an alarm if needed to ensure that your child is taking their medicines on time.

2. Follow-Up Visits

Keep up with all the follow-up visits as recommended by the doctor. This will help the doctor monitor your child’s progress and make any changes or write additional tests if needed. You must also be well-informed about any side effects to look out for so that you can contact your doctor immediately if your child shows any reactions to the medications.

3. Diet and Exercise

Tuberculosis is a wasting infection that can create lethargy, loss of weight, loss of appetite, and a general feeling of unwellness in your child. Parents and caretakers should ensure that the child has a balanced diet, gets proper sleep and a good amount of exercise as well. Your doctor can advise you on these aspects. Following them to the T will allow your child to recover quickly from fatigue and other secondary symptoms.

4. Emotional Help

TB-infected children can take a while to recover from the infection. During this time, parents must provide all the emotional support and help keep up the spirit of their child. The child, unable to move out much and battling with the symptoms, can often feel let-down and depressed. At this stage, parents providing emotional support can be of great help. Parents also must ensure that their child stays at home and does not mix with other children to prevent the spread of this infection.

How to Prevent My Child From Getting Tuberculosis?

Since TB is an air-borne infection, it may be difficult to predict how and when your child can contract the infection. However, a few simple steps can prevent your child from suffering from an active infection.

• Keep your child away from known cases of TB.
• If anyone in your family is infected with TB, let them isolate themselves. Keep a separate set of utensils for them to avoid the spread of infection.
• Good immunity is the key to avoiding the conversion of latent TB to active TB. Encourage your child to have a healthy and balanced diet rich in protein that covers all food groups. A proper diet and exercise are the key to preventing tuberculosis in your child.
• Talk to your child’s doctor about the BCG vaccine if your child has not got their vaccination.

[Read : Healthy Eating – Ways to Inculcate Healthy Eating Habits in Kids]

When to Call Your Doctor?

Staying informed about the symptoms and identifying them at the right time are the crucial first steps to fighting TB. The moment you suspect an infection either due to symptoms or due to exposure to a known case, you can consult a paediatrician. They will guide you through the right steps of diagnosis and treatment.

Look for the following symptoms:

• Low grade or high fever that continues for more than a week
• Dry cough (with no sputum)
• Chest pain
• Loss of appetite
• Loss of weight
• Coughing up blood in sputum
• Breathlessness

You must also consult your doctor if your child is having severe reactions to the medications in the course of treatment.

There was a time when TB was a worrying disease, but not anymore. With advanced testing and treatment options and increased medical knowledge, treatment and recovery have become easy. Just remember to consult your doctor at the earliest suspicion, get the tests done, and follow the treatment protocols religiously. Your child will recover and get back to a healthy normal within time.

FAQ’s

1. At What Age Can You Test Children For TB?

TB can happen at any age. Children below the age of four and children nearing puberty are more susceptible to this infection. You can get your child tested if they show symptoms such as a long-drawn fever, dry cough that lasts for more than a week, fatigue, lack of appetite and sudden weight loss.

2. How Do You Know if Your Child Has TB?

If your child is showing symptoms like high fever, continuous cough, blood in sputum, and fatigue, you must immediately take your child to the doctor. The doctor will check your child’s medical history and run a few tests which will confirm if your child has got the infection.

3. Is TB Curable Permanently Among Children?

Yes!! The right doctor, timely diagnosis and proper treatment protocol can ensure that your child gets treated permanently.

Read Also: Pneumonia in Children – Causes, Symptoms And Treatment by Dr. Srikanta J T