The Indian Journal of Pediatrics

, Volume 78, Issue 3, pp 328–333 | Cite as

Changing Trends in Childhood Tuberculosis

Symposium of Pediatric Tuberculosis


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.


Childhood tuberculosis Epidemiology Flourescence LED microscopy Nucleic acid amplification tests Line probe assay IGRA DOTS DOTS plus 


  1. 1.
    WHO. Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371).Google Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Enarson DA. The International Union Against Tuberculosis and lung disease model national tuberculosis programs. Tuber Lung Dis. 1995;76:95–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Udani PM. BCG Vaccination in India and tuberculosis in children. Indian J Pediatr. 1995;61:451–62.CrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    World Health Organization. TB Factsheet 2009 update. Available at . Accessed on 10.10.2010
  7. 7.
    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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Merchant RH, Oswal JS, Bhagwat RV, et al. Clinical profile of HIV infection. Indian Pediatr. 2001;38:239–46.PubMedGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Dhurat R, Manglani M, Sharma M, et al. Clinical spectrum of HIV infection. Indian Pediatr. 2000;37:831–6.PubMedGoogle Scholar
  13. 13.
    Hunn P, Felten M. Surveillence of resistance to antituberculosis drugs in developing countries. Tuber Lung Dis. 1994;75:163–7.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB): Global report on surveillance and response. Geneva: WHO; 2010.Google Scholar
  18. 18.
    TB India 2010: RNTCP Status Report (accessed on 10.10.2010)
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    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 Mycobacterium tuberculosis. J Clin Microbiol. 2002;40:150–4.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Kabra SK, Lodha R, Seth V. Some current concepts on childhood tuberculosis. Indian J Med Res. 2004;120:387–97.PubMedGoogle Scholar
  29. 29.
    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.Google Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    New Diagnostics Working Group of the Stop TB Partnership .Pathways to better diagnostics for tuberculosis—A blueprint for the development of TB diagnostics. 2009.Google Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    Kampmann B, Tena-Coki G, Anderson S. Blood tests for diagnosis of tuberculosis. Lancet. 2006;368:282–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Cox HS, Morrow M, Deutschmann PW. Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ. 2008;336:484–7.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    Kabra SK, Lodha R, Seth V. Category based treatment of tuberculosis in children. Indian Pediatr. 2004;41:927–37.PubMedGoogle Scholar
  38. 38.
    Amdekar YK, Singh V, Kabra SK, et al. Consensus statement on childhood tuberculosis. Indian Pediatr. 2010;47:41–55.CrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    World Health Organization. Report of the meeting on TB medicines for children WHO Headquarters, Geneva, Switzerland. July 2008.Google Scholar
  42. 42.
    Lodha R, Menon PR, Kabra SK. Concerns on the dosing of antitubercular drugs for children in RNTCP. Indian Pediatr. 2008;45:852–4.PubMedGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    Stop TB partnership. Working group on new TB drug. Accessed at on 10.10.2010
  45. 45.
    Sivanandan S, Walia M, Lodha R, Kabra SK. Factors associated with treatment failure in childhood tuberculosis. Indian Pediatr. 2008;45:769–71.PubMedGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2010

Authors and Affiliations

  1. 1.Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations