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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