Diagnosis of tuberculosis in children.

Diagnosis of tuberculosis (TB) in children is usually based on presumptions from several elements: clinical picture and course x-rays tuberculin test and culture of pathology later on. TB is usually found in a child because of symptoms of primary disease or through case-finding of a contact. TB is children is often a primary infection and may be gradual or acute in onset. Some of the symptoms of primary TB are low-grade fever pallor fatigue and anorexia. The child may have erythema nodosum a yellow module on the conjunctiva hilar or mediastinal lymphadenopathy a primary TB complex on the lung (3-10 mm) segmental density or a positive PPD test. Children with pulmonary disease do not have adult-type cavity lesions but may have a primary cavity that drains into the bronchi mechanical complications fistulas or atelectasis. Acute TB often appears as meningitis. The pathognomonic signs are cerebrospinal fluid high in lymphocytes with very high albumin (0.6-2 g) and low glucose (0.4-0.2 g/l). TB organisms are rarely seen but may be cultured. TB meningitis is also notable for choroidal tubercles which are yellow nodules visible in the fundus. These presumptive signs as well as increasing neurological findings prompt immediate treatment. Children also may have acute miliary TB marked by high fever gastrointestinal symptoms hepatosplenomegaly dyspnea cyanosis and respiratory distress with characteristic diffuse grainy spots on the chest x-ray. A child may have both conditions and may also have localized TB infection elsewhere. Thus clinical findings may point to possible cultures of urine gastric lavage pleural fluid or biopsy pericardial fluid bone marrow or ascitic fluid any of which should be cultured to rule out other causes. The most common sites for extra-pulmonary TB are cervical nodes spine knee. shoulder hip and peritoneum. Pelvic and urinary tract infections are rare in children.