Tuberculosis in Infants and Children

This chapter focuses on the fundamental nature of exposure and infection of pediatric tuberculosis, emphasizing how and why children should be approached differently from adults. The effects of these differences on the public health approach to tuberculosis control in children are also explained in the chapter. Disease occurs when signs or symptoms or radiographic manifestations caused by Mycobacterium tuberculosis become apparent. Infants are more likely to experience signs and symptoms, probably because of their small airway diameters relative to the parenchymal and lymph node changes in primary tuberculosis. The hallmark of primary pulmonary tuberculosis is the relatively large size and importance of the lymphadenitis compared with the less significant size of the initial parenchymal focus. The most common manifestations are at the anatomic site of the existing tuberculosis, but new onset of tuberculomas, lymphadenopathy, and abdominal manifestations can occur. As with tuberculin skin test (TSTs), gamma interferon release assays (IGRAs) cannot distinguish between latent infection and disease, and a negative result from these tests cannot exclude the possibility of tuberculosis infection or disease in a patient with findings that raise suspicion for these conditions. The chapter gives current recommendations for use of gamma IGRAs in children. The main form of nucleic acid amplification studied in children with tuberculosis is the PCR, which uses specific DNA sequences as markers for microorganisms. An expert in tuberculosis always should be involved in the management of children with drug-resistant tuberculosis infection or disease.