- 354 Downloads
Childhood tuberculosis (TB) represents an important part of the disease burden, yet its diagnosis remains challenging. This review summarizes the clinical, radiological, and bacteriological approaches to diagnose TB infection and disease in children. Fever (possibly intermittent or low grade), weight loss or failure to thrive, and a persistent cough for >2 weeks are the most important clinical signs for pulmonary tuberculosis. Extra-pulmonary TB, which might occur in over 40% of the patients, can have in addition some specific clinical symptoms or signs. Chest radiographs provide important information in many patients and advanced imaging can be applied in case of (and should be restricted to) inconclusive diagnosis. The Mantoux test is positive in up to 70% of non-immunocompromised TB patients, whereas HIV co-infection or malnourishment results in a lower reactivity. Evidence of an adult TB index case is clue for diagnosis of childhood TB in low-endemic countries. Bacteriological confirmation remains difficult and is useful for doubtful cases or when drug resistance is suspected.
KeywordsChildren Tuberculosis Diagnosis Disease Infection
Conflict of interest
The writing of this review manuscript was not sponsored. The author declares not to have a financial relationship with any of the studies mentioned in the manuscript.
- 1.American Academy of Pediatrics (1994) Screening for tuberculosis in infants and children. Pediatrics 93:131–134Google Scholar
- 3.Basu S, Ganguly S, Chandra PK, Basu S (2007) Clinical profile and outcome of abdominal tuberculosis in Indian children. Singap Med J 48:900Google Scholar
- 4.Connell TG, Ritz N, Paxton GA et al (2008) A three-way comparison of tuberculin skin testing, quantiFERON-TB gold and T-SPOT.TB in children. PloS 3:e2624Google Scholar
- 5.De Villiers RVP, Savvas A, Van de Westhuizen S (2004) Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high-kilovolt radiographs. Australas Radiol 48:148–153. doi: 10.1111/j.1440-1673.2004.01276.x PubMedCrossRefGoogle Scholar
- 21.Morcillo N (2007) Chapter 16: tuberculosis in children. In: Palomino JC, Leão SC, Ritacco V (eds) Tuberculosis 2007 from basic science to patient care. Brazil, pp 525–530Google Scholar
- 22.Munoz FM, Starke JR (2006) Childhood tuberculosis. In: Raviglione MC (ed) Reichman and Hershfield’s tuberculosis: a comprehensive, international approach, 3rd edn, part 1, vol 219. Informa Healthcare USA, New York, pp 307–344Google Scholar
- 23.Musoke Mudido P, Guwatudde D, Nakakeeto MK et al (1999) The effect of bacille Calmette–Guérin vaccination at birth on tuberculin skin test reactivity in Ugandan children. Int J Tuberc Lung Dis 3:891–895Google Scholar
- 26.Rehman A, Infranullah (2007) Interferon gamma assays for tuberculosis in children. J Pak Med Assoc 58:508–511Google Scholar
- 32.Starke JR (2000) Tuberculosis in childhood and pregnancy. In: Friedman LN (ed) Tuberculosis: current concepts and treatment (2nd edn). CRC, Boca Raton, pp 191–229Google Scholar
- 35.WHO (2006) Guidance for national tuberculosis programmes on the management of tuberculosis in children. WHO/FCH/CAH/2006.7Google Scholar
- 36.WHO (2008) Laboratory-based evaluation of 19 commercially available rapid diagnostic tests for tuberculosis. In: WHO diagnostics evaluation series, no. 2Google Scholar