Early Diagnosis and Treatment of Tuberculosis in Children

For the early diagnosis of tuberculosis in children, routine tuberculin testing and a careful and detailed history are of prime importance. A. careful physical examination should also be done although in the early primary infection it most likely will be entirely negative. Chest x-ray filma are not as specific as is the tuberculin test but they are more specific than the symptoms, and they are very important. It is difficult to obtain a. definitive x-ray film on a squirming child but it is impossible to make a diagnosis on a poor film. An apparently negative film does not rule out. active tuberculosis, especially in the tuberculin-converter with recent. heavy tuberculosis exposure. Miliary and meningitis develop in some babies whose films showed little or no evidence of a primary complex.. Calcium deposits sometimes appear later in serial x-ray films at the site where only equivocal soft shadows were visible on the first films. After the 9 per cent miliary cases and the 2 per cent reinfection pulmonary cases are excluded the incidence of initial positive gastric cultures among the remaining 89 per cent of the in-sanatorium children is about 27 per cent. Positive gastrics are not uncommonly associated with these equiv-. ocal shadows. The fact that primary tuberculosis lesions may be hidden in the routine x-ray film by the heart, mediastinal structures, large vessels or the� diaphragm is well known. Dr. J. A. Myers reports that comparison of: antemortem chest films and autopsy findings show that posteroanterior films of the chest fail to reveal 90 to 95 per cent of recent primary lesions; and 70 to 90 per cent of long standing primary lesions. Dr. Henry Sweany found at autopsy that 31 per cent of pulmonary lesions were so located that they were obscured in the posteroanterior chest films. In addition 10 to 15 per cent of tuberculosis lesions are extrapulmonary and would,. therefore, be missed by the routine chest film. These facts must be kept; in mind when evaluating any case from the standpoint of tuberculosis.. Histoplasmosis may cause either the primary type or miliary type lesions in the lungs: foreign bodies in a bronchus may cause lesions resembling those of the atelectasis distal to bronchial obstructive types of primary tuberculosis and not infrequently the roentgenologist’s report concludes with “please repeat x-ray film in two weeks to rule out pneumonia.” In taking the history one must remember that dates in children are of considerably more importance than in adults; e.g., date of babyhood and of puberty, date of beginning and end of contact with “open” tuberculosis, *presenthd at the 23rd Annual Meeting, American College of Chest Physicians, New