Changing Trends in Childhood Tuberculosis Authors
Symposium of Pediatric Tuberculosis
First Online: 15 December 2010 Received: 21 October 2010 Accepted: 12 November 2010 DOI:
Cite this article as: Mukherjee, A., Lodha, R. & Kabra, S.K. Indian J Pediatr (2011) 78: 328. doi:10.1007/s12098-010-0298-4
Several changes have been observed in the epidemiology, clinical manifestations, diagnostic modalities and treatment of tuberculosis. Emergence of HIV epidemic and drug resistance have posed significant challenges. With increase in the number of diseased adults and spread of HIV infection, the infection rates in children are likely to increase. It is estimated that in developing countries, the annual risk of tuberculosis infection in children is 2.5%. Nearly 8–20% of the deaths caused by tuberculosis occur in children. Extra pulmonary tuberculosis has increased over last two decades. HIV infected children are at an increased risk of tuberculosis, particularly disseminated disease. In last two decades, drug resistant tuberculosis has increased gradually with emergence of MDR and XDR-TB. The rate of drug resistance to any drug varied from 20% to 80% in different geographic regions. Significant changes have occurred in TB diagnostics. Various diagnostic techniques such as flourescence LED microscopy, improved culture techniques, antigen detection, nucleic acid amplification, line probe assays and IGRAs have been developed and evaluated to improve diagnosis of childhood tuberculosis. Serodiagnosis is an attractive investigation but till date none of the tests have desirable sensitivity and specificity. Tests based on nucleic acid amplification are a promising advance but relatively less experience in children, need for technical expertise and high cost are limiting factors for their use in children with tuberculosis. Short-course chemotherapy for childhood tuberculosis is well established. Directly observed treatment strategy (DOTS) have shown encouraging result. DOTS plus strategy has been introduced for MDR TB.
Flourescence LED microscopy
Nucleic acid amplification tests
Line probe assay
WHO. Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371).
Chadha VK, Kumar P, Jagannatha PS, et al. Average annual risk of tuberculous infection in India. Int J Tuberc Lung Dis. 2005;9:116–8.
Enarson DA. The International Union Against Tuberculosis and lung disease model national tuberculosis programs. Tuber Lung Dis. 1995;76:95–9.
Udani PM. BCG Vaccination in India and tuberculosis in children. Indian J Pediatr. 1995;61:451–62.
Sanchez-Albisua I, Baguaero-Artigao F, Castillo FD, Borque C, Gorcia Miguel MJ, Vidal ML. Twenty years of pulmonary tuberculosis in children; What has changed? Pediatr Infect Dis J. 2002;21:49–53.
World Health Organization. TB Factsheet 2009 update. Available at
Accessed on 10.10.2010
Antouhucci G, Girardi E, Raviglione MC, Ippolite G. Risk factors for tuberculosis in HIV infected persons a prospective cohort study. JAMA. 1995;274:143–8.
Sassan-Morakam M, Delockk M, Achah A. Tuberculosis and HIV infection in children in Abidjan, Cote D’ Ivoire. Trans R Soc Trop Med Hyg. 1994;58:178–81.
Chintu C, Bhat G, Luo C. Seroprevalence of human immunodeficiency virus type I infection in Zambian children with tuberculosis. Pediatr Infect Dis J. 1993;12:499–504.
Merchant RH, Oswal JS, Bhagwat RV, et al. Clinical profile of HIV infection. Indian Pediatr. 2001;38:239–46.
Lodha R, Upadhyay A, Kapoor V, Kabra SK. Clinical features and natural history of children with HIV infection. Indian J Pediatr. 2006;73:201–4.
Dhurat R, Manglani M, Sharma M, et al. Clinical spectrum of HIV infection. Indian Pediatr. 2000;37:831–6.
Hunn P, Felten M. Surveillence of resistance to antituberculosis drugs in developing countries. Tuber Lung Dis. 1994;75:163–7.
Pablos-Mendez A, Raviglion MC, Laszlo A, et al. Global surveillance for antituberculosis drug resistance 1994¬1997. N Engl J Med. 1998;338:1941–9.
Nelson LJ, Schneider E, Wells CD, Moore M. Epidemiology of childhood tuberculosis in the United States, 1993–2001: the need for continued vigilance. Pediatrics. 2004;114:333–41.
Schaaf HS, Marias BJ, Hesseling AC, Gie RP, Beyers N, Donald PR. Childhood drug resistant tuberculosis in the western Cape province of South Africa. Acta Paediatr. 2006;95:523–8.
World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB): Global report on surveillance and response. Geneva: WHO; 2010.
TB India 2010: RNTCP Status Report
(accessed on 10.10.2010)
Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet. 2005;365:130–4.
Singh M, Moosa NV, Kumar L, et al. Role of gastric lavage and bronchoalveolar lavage in the bacteriological diagnosis of childhood pulmonary tuberculosis. Indian Pediatr. 2000;37:947–51.
Steingart KR, Henry M, Ng V, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006;6:570–81.
Marais BJ, Brittle W, Painczyk K, et al. Use of light-emitting diode fluorescence microscopy to detect acid-fast bacilli in sputum. Clin Infect Dis. 2008;47:203–7.
Satti L, Ikram A, Abbasi S, Malik N, Mirza IA, Martin A. Evaluation of thin-layer agar 7 H11 for the isolation of Mycobacterium tuberculosis complex. Int J Tuberc Lung Dis. 2010;14:1354–6.
Venkatraman P, Herbert D, Paramasivan CR, et al. Evaluation of the BACTEC radiometric method in the early diagnosis of tuberculosis. Indian J Med Res. 1998;108:120–7.
Bemer P, Palicova F, Rusch-Gerdes S, Drugeon HB, Pfyffer GE. Multicentre evaluation of fully automatic BACTEC mycobacteria growth indicator tube 960 system for susceptibility testing of
. J Clin Microbiol. 2002;40:150–4.
Sewell DL, Rashad AL, Rourke Jr WJ, et al. Comparison of the Septi-Chek AFB and BACTEC systems and conventional culture for recovery of mycobacteria. J Clin Microbiol. 1993;31:2689–91.
Moore DA, Mendoza D, Gilman RH, et al. Microscopic observation drug susceptibility assay, a rapid, reliable diagnostic test for multidrug-resistant tuberculosis suitable for use in resource-poor settings. J Clin Microbiol. 2004;42:4432–7.
Kabra SK, Lodha R, Seth V. Some current concepts on childhood tuberculosis. Indian J Med Res. 2004;120:387–97.
Noordhock GT, Kolk AH, Bjune G, et al. Sensitivity and specificity of PCR for detection of Mycobacterium tuberculosis: a blind comparison study among seven laboratories. J Clin Microbiol. 1994;32:277–84.
Boehme C, Nabeta P, Henostroza G, et al. Operational feasibility of using loop-mediated isothermal amplification for diagnosis of pulmonary tuberculosis in microscopy centers of developing countries. J Clin Microbiol. 2007;45:1936–40.
New Diagnostics Working Group of the Stop TB Partnership .Pathways to better diagnostics for tuberculosis—A blueprint for the development of TB diagnostics. 2009.
Steingart KR, Henry M, Laal S, et al. A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Postgrad Med J. 2007;83:705–12.
Dheda K, Davids V, Lenders L, et al. Clinical utility of a commercial LAM-ELISA assay for TB diagnosis in HIV-infected patients using urine and sputum samples. PLoS ONE. 2010;5:e9848.
Kampmann B, Tena-Coki G, Anderson S. Blood tests for diagnosis of tuberculosis. Lancet. 2006;368:282–3.
Cox HS, Morrow M, Deutschmann PW. Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ. 2008;336:484–7.
Menon PR, Lodha R, Sivanandan S, Kabra SK. Intermittent or daily short course chemotherapy for tuberculosis in children: meta analysis of randomized controlled trials. Indian Pediatr. 2010;47:67–73.
Kabra SK, Lodha R, Seth V. Category based treatment of tuberculosis in children. Indian Pediatr. 2004;41:927–37.
Amdekar YK, Singh V, Kabra SK, et al. Consensus statement on childhood tuberculosis. Indian Pediatr. 2010;47:41–55.
Schaaf HS, Willemse M, Cilliers K. Rifampin pharmacokinetics in children, with and without human immunodeficiency virus infection, hospitalized for the management of severe forms of tuberculosis. BMC Med. 2009;7:19.
McIlleron H, Willemse M, Werely CJ, et al. Plasma Isoniazid concentrations in a cohort of South African children with tuberculosis: implications for international pediatric dosing guidelines. Clin Infect Dis. 2009;48:1547–53.
World Health Organization. Report of the meeting on TB medicines for children WHO Headquarters, Geneva, Switzerland. July 2008.
Lodha R, Menon PR, Kabra SK. Concerns on the dosing of antitubercular drugs for children in RNTCP. Indian Pediatr. 2008;45:852–4.
Ma Z, Lienhardt C, McIlleron H, Nunn AJ, Wang X. Global tuberculosis drug development pipeline: the need and the reality. Lancet. 2010;375:2100–9.
Stop TB partnership. Working group on new TB drug. Accessed at
Sivanandan S, Walia M, Lodha R, Kabra SK. Factors associated with treatment failure in childhood tuberculosis. Indian Pediatr. 2008;45:769–71.
Scriba TJ, Tameris M, Mansoor N, et al. Modified vaccinia Ankara-expressing Ag85A, a novel tuberculosis vaccine, is safe in adolescents and children, and induces polyfunctional CD4+ T cells. Eur J Immunol. 2010;40:279–90.
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