Childhood Pulmonary Tuberculosis

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    Childhood Pulmonary

    TuberculosisMarais, B.J. et al. 2006. American Journal Respir

    Crit Care Med Vol. 173 pp. 1078-1090

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    Contents

    Concepts from the Natural History of DiseaseCase Definition

    Risk Stratification

    Disease Diversity

    DiagnosisTreatment

    Preventive Chemotherapy

    Curative Treatment

    RetreatmentHIV Infection

    Drug Resistance

    Reducing the Burden of Childhood TB

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    Abstract

    Childhood tuberculosis is neglected in

    endemic areas with resource constraints.

    They contribute a significant proportion of the

    disease burden and suffer severe TB-related

    mortality and morbidity.

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    Abstract

    The natural history of disease is in theseconcepts:

    1. accurate case definition

    2. importance of risk stratification

    3. diverse spectrum of the diseasepathology

    The relevance of these concepts andapplication in relation to diagnosis andtreatment.

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    Case Definition

    1. Primary Infectiona previously uninfected

    child inhales a single infectious aerosol

    droplets that penetrates the terminal

    airways.

    recently infected who are not diseased.

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    Case Definition

    2. Active Diseaseexposure + symptomatic +

    CXray + PPD + Labs

    3 or more/5 criteria

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    Uncomplicated hilar adenopathy remains the

    most common disease manifestation in

    children, hallmark of primary TB.

    In nonendemic areas where contact tracing is

    diligently enforced, more children with

    transient radiologic signs indicative of recent

    primary infection will be identified.

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    Risk Stratification

    Age is the most important variable

    determining the risk of progression to disease

    after an infection in immunocompetent.

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    Age-Specific Risk to Progress to Disease After Primary Infection with MTb in

    Immunocompetent Child

    Age at

    Primary

    Infection(year)

    Risk to Progression to Disease

    1 No disease (50%), pulmonary disease (30-40%), disseminated disease or

    TB meningitis(10-20%)

    1-2 No disease (75-80%), pulmonary disease (10-20%), disseminated diseaseor TB meningitis(2-5%)

    2-5 No disease (95%), pulmonary disease (5%), disseminated disease or TB

    meningitis(0.5%)

    5-10 No disease (98%), pulmonary disease (2%), disseminated disease or TB

    meningitis( 10 No disease (80-90%), pulmonary disease (10-20%), disseminated disease

    or TB meningitis(

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    Risk Stratification

    Children with HIV infection and other forms of

    immune compromise (severe malnutrition)

    are also high risk of acquiring TB.

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    Disease Diversity

    1. Containment2. Luminal compression of LN

    3. Radiologic signs

    4. Pathology: transient parenchymalconsolidation to expansile pneumonic

    process with caseation in the affected

    segment

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