Tuberculosis
Etiology
Mycobacterium tuberculosis complex:
- Mycobacterium tuberculosis
- Mycobacterium bovis
Congenital
Miliary (millet seed appearance of lung on autopsy, and later on X-ray)
Now describes any disseminated aka generalise disease (inc polyserositis (pericard, pleur, peritoneal) and generalised lymphadenopathy)
Immunosuppression (HIV)
Pulmonary TB is the most common presentation in children
Often Asymptomatic (particularly 5-10yo)
Ix
Tuberculin skin test (TST) positive in active and latent TB
CXR + CXR of carer giver
Expectorated / Induced Sputum / Gastric aspirate (3 specimens)
- microscopy for acid fast bacilli
- culture
Tissue histology for AFB and bacterial culture
If <1yo LP regardless of neurological symptoms
HIV testing
Diagnosis
1) Contact with infective pt (smear pos for AFB) AND
2) TST or IGRA positive AND
3) Symtpoms / CXR findings
(significant number never AFB/culture positive)
NB the contact may not have been diagnosed yet so at risk adult > confirming the adult confirms the child
Rx
Prevention
BCG
Contact tracing
-========
Infects
Resp
lymphadenitis: hilar, mediastinal, tracheobronchial,
rhinitis
sinusitis
pharyngitis
bronchitis
glottis
laryngitis
tracheitis
Pneumonia
Pneumothorax
Pulmonary fibrosis
Bronchiectasis
Pleurisy (pleura, empyema)
Meningitis
Leptomeningitis
meningeal tuberculoma
Encephalitis
Cerebral access
myelitis
polyneuropathy
cerebral arteritis
myocarditis
pericarditis
endocarditis
septic arthritis
osteitis
osteomyelitis
bone necrosis
synovitis
tenosynovitis
mastoiditis
otitis media
cystitis
cervicitis
pyelonephritis
ureteritis
PID
male genital (urethritis...
oesophagitis
gastritis?
enteritis
colitis
anus and rectum
ascites
lymphadenitis mesenteric and retroperitoneal
Cutaneous TB:
Erythema induratum
Lupus exedens
Lupus vulgaris
Scrofuloderma
chorioretinitis
episcleritis
interstitial keratitis
iridocyclitis
keratoconjunctivitis (interstitial)(phlyctenular)
Addison disease
thyroiditis
Mycobacterium tuberculosis complex:
- Mycobacterium tuberculosis
- Mycobacterium bovis
Congenital
Miliary (millet seed appearance of lung on autopsy, and later on X-ray)
Now describes any disseminated aka generalise disease (inc polyserositis (pericard, pleur, peritoneal) and generalised lymphadenopathy)
Immunosuppression (HIV)
Pulmonary TB is the most common presentation in children
- Cough >3weeks
- Fever (>38C) for >2weeks
- Wt loss or failure to thrive
Often Asymptomatic (particularly 5-10yo)
Ix
Tuberculin skin test (TST) positive in active and latent TB
- false positive in non-mycobacterium / previous BCG / incorrect administration/interpretation
- false neg in <6mo, overwhelming TB, immunosuppression (HIV), incorrect administration/interpretation
CXR + CXR of carer giver
Expectorated / Induced Sputum / Gastric aspirate (3 specimens)
- microscopy for acid fast bacilli
- culture
Tissue histology for AFB and bacterial culture
If <1yo LP regardless of neurological symptoms
HIV testing
Diagnosis
1) Contact with infective pt (smear pos for AFB) AND
2) TST or IGRA positive AND
3) Symtpoms / CXR findings
(significant number never AFB/culture positive)
NB the contact may not have been diagnosed yet so at risk adult > confirming the adult confirms the child
Rx
- DOT M/W/F (daily if HIV)
- For new smear neg pulmonary or mild extra pulmonary TB
- Isoniazid and Rifampicin for 6 months (12m if meningitis/osteoarticular)
- PLUS pyrazinamide for first 2 months
- IF osteoarticular OR smear pos OR neg with extensive pulm or non-pulm OR HIV ADD ethambutol for first 2 months
- IF Meningitis substitute ethambutol with streptomycin, amikacin or ethionomide
- Drug resistance, or refractory / relapse as per ID
- For new smear neg pulmonary or mild extra pulmonary TB
- Report to public health
Prevention
BCG
Contact tracing
-========
Infects
Resp
lymphadenitis: hilar, mediastinal, tracheobronchial,
- Painless, fixed lymph nodes particularly cervical
rhinitis
sinusitis
pharyngitis
bronchitis
glottis
laryngitis
tracheitis
Pneumonia
Pneumothorax
Pulmonary fibrosis
Bronchiectasis
Pleurisy (pleura, empyema)
Meningitis
Leptomeningitis
meningeal tuberculoma
Encephalitis
Cerebral access
myelitis
polyneuropathy
cerebral arteritis
myocarditis
pericarditis
endocarditis
septic arthritis
osteitis
osteomyelitis
bone necrosis
synovitis
tenosynovitis
mastoiditis
otitis media
cystitis
cervicitis
pyelonephritis
ureteritis
PID
male genital (urethritis...
oesophagitis
gastritis?
enteritis
colitis
anus and rectum
ascites
lymphadenitis mesenteric and retroperitoneal
Cutaneous TB:
Erythema induratum
Lupus exedens
Lupus vulgaris
Scrofuloderma
chorioretinitis
episcleritis
interstitial keratitis
iridocyclitis
keratoconjunctivitis (interstitial)(phlyctenular)
Addison disease
thyroiditis