11. TB in children

In the settings with high tuberculosis prevalence, tuberculosis is one of the major causes of pediatric morbidity and mortality. Diagnostic methods used in a pediatric population are not accurate and there is a high possibility that the burden of pediatric TB is underestimated. According to the WHO at least half a million of children are infected with TB each year and 10-20% of all TB cases in high prevalent settings are pediatric.

Main characteristics of Tuberculosis infection in children

Children have a high risk of TB infection progressing to active TB disease, especially very young children (age < 5) and those with immunosuppresion (HIV, post-measels, malnutrition). Any child living in a setting where there are people with TB, can become infected, even if vaccinated.

The main source of TB infection for children are usually their close contacts. Therefore, a very detailed TB contact history if very importnant and identification of a contact is easier in smaller children (e.g. all mothers or other care takers who are bringing children with TB symptoms to the health care center should be screened for TB themselves) . Equally, children who are contacts of  adult TB patients, particularly those with smear positive pulmonary TB, should be screened for TB symptoms.

70-80% of pediatric tuberculosis is located in the lungs (PTB), but EPTB can also develop in children and its location is age specific - miliarry TB and TB meningitis are more frequent in young children, TB lymphadenitis and osteoarticular TB are more frequent in older children.