Tuberculosis In Children - Signs, Symptoms, Prevention And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Signs, symptoms, prevention and treatment of tuberculosis in children

Content:

• Symptoms of tuberculosis in children
• Types of tuberculosis in children
• Diagnosis of tuberculosis in children
• Treatment of tuberculosis in children
• Prevention of tuberculosis in children

Tuberculosis is a disease caused by Koch's bacillus. It is much harder for children than for adults. Due to the unformed immunity, it is difficult for the body to respond with a protective function to the infection and localize it in one area.

Extensive organ damage leads to irreversible consequences. Therefore, it is important to recognize the disease in time and begin treatment.

Symptoms of tuberculosis in children

The first manifestations of the disease are similar to a cold and may not be taken seriously by parents. This is a cough, fever, lethargy and apathy. If after 3 weeks the signs do not go away, then the disease may develop.

The disease has common symptoms characteristic of all its types:

• irritability;
• loss of appetite;
• weight loss;
• sweating and chills;
• enlarged lymph nodes.

The following manifestations indicate that the chronic stage has begun:

• lag in physical development;
• pallor and dry skin;
• sleep disturbance;
• a state of mild euphoria;
• enlargement of the liver.

There are also symptoms that diagnose a specific location of infection.

The following symptoms occur with the most common type of tuberculosis - pulmonary:

• General fatigue - weakness after a night's sleep, poor performance at school, absent-mindedness, insomnia, poor appetite.
• Painful appearance - excessive thinness, pallor of the skin, unhealthy blush and glitter in the eyes.
• Periods of temperature rise are observed for a long time. This often occurs at night and is accompanied by chills and sweating. This symptom is a sure sign of illness.
• Cough. Also, the presence of a pulmonary lesion is indicated by a dry and then wet cough that does not pass for 3 weeks.

• Sputum with blood is a sign of bleeding in the lung. If you notice drops on a handkerchief in a child after a coughing attack, you should immediately call an ambulance.

Other signs of tuberculosis

In children, the disease occurs in an acute form and penetrates not only the lungs, but also other organs.

Symptoms are easy to confuse with the manifestations of various diseases, therefore, at the diagnostic stage, all acceptable options are excluded:

• The defeat of the meninges is accompanied by a bad mood, insomnia. Later, vomiting, headaches and cramps may occur. If you discover the disease at a later date, you can lose your child. The risk of infection increases in those families who have a carrier of tuberculosis.
• Gastrointestinal tuberculosis manifests itself in disorders of the functions of the digestive system: constipation or diarrhea, pain, blood in the stool and fever.
• The defeat of the joints and bones is accompanied by pain during movement, immobility, frequent fractures, and later lameness appears.
• Infection of the genitourinary system has symptoms such as back pain, painful urination with blood elements, fever. Girls who have had this species may subsequently become infertile.
• Skin lesions are characterized by compaction and enlargement of the lymph nodes, suppuration and rupture of the membrane.

Types of tuberculosis in children

In children of younger preschool age, not only the lungs are affected, but also other organs, and such forms of the disease as tuberculous meningitis, primary tuberculosis complex and miliary tuberculosis are more common. The main reasons are contact with an infected person and the lack of BCG vaccination.

Tuberculous meningitis

This species affects the lining of the brain. In the case of children, it is rapidly progressive. At the same time, headaches, a systematic increase in temperature, a sluggish state and changes in mood are observed. Within 2 weeks, the condition changes to extremely severe - vomiting, constipation, weakening of the facial muscles, slow pulse, eye inflammation begin.

In tuberculous meningoencephalitis, individual parts of the brain that are responsible for various functions are affected. In such cases, analysis of cerebrospinal fluid, CTG and a complete examination of the lungs is necessary. Unfortunately, tuberculous meningitis in most cases is accompanied by associated diseases. Therefore, a competent diagnosis should include an examination for the presence of viral and fungal diseases.

Recovery requires more than a year of systematic hospitalization. In this case, general treatment and additional treatment are carried out, as symptoms arise.

Primary tuberculosis complex

It is characterized by high fever, reaching 40 °, coughing and pain in the lungs. Breathing becomes irregular, wheezing, loss of strength, loss of appetite are observed. The disease confirms the presence of a pneumatic focus in the lung, as well as infection of the regional intrathoracic lymph nodes.

To establish the diagnosis, a Mantoux test and an X-ray of the lungs are performed. Treatment is carried out with the help of chemotherapy and pathogenetic effects in a hospital setting.

Miliary tuberculosis

Extensive lesion with tuberculous vesicles.

The disease is acute and mainly affects the respiratory system, spleen and kidneys. There are two types of disease:

1. Acute tuberculous sepsis - standard studies cannot detect the presence of the disease, the symptoms are rather vague, therefore, the patient dies after a few weeks.
2. Acute miliary tuberculosis - begins with acute intoxication, difficulty breathing, high temperature. At the primary stage, limited miliary tuberculosis occurs, which, if untreated, becomes extensive.

When diagnosing an ultrasound scan, an increase in the spleen and liver is found. Blood, urine, and chest x-rays are also done. Tuberculin tests show false results.

Several anti-tuberculosis drugs are used simultaneously for treatment. Its duration is 6 months. In addition, physiotherapy, immunomodulators and breathing exercises are prescribed.

Children of preschool and primary school age suffer from manifestations of the disease to a lesser extent. They are dominated by mild forms of the disease, which are located in small areas of the affected organs.

Tuberculosis of the intrathoracic lymph nodes

It affects areas of the respiratory system such as the root and mediastinum. It is characterized by low-grade fever, loss of appetite and weight, adynamia and nervous excitement. Sleep disturbance and increased sweating are also noted among the symptoms.

During the diagnosis, tests are prescribed to identify MBT and X-rays. The effectiveness of treatment depends on the first 3 months when the combination of the strongest drugs is used. If there is a positive result, then the number of drugs is reduced to two.

Peripheral lymph node tuberculosis

The most susceptible to infection are the nodes located under the jaws, on the neck and chin. The disease is characterized by painlessness and mobility of the nodes in which casein necrosis is found. As the inflammation grows, the skin above it breaks through and a fistula appears, filled with purulent masses. Later, a scar forms in its place.

You should also pay attention to the temperature rise up to 40 °, general weakness and pain in the head. For diagnosis, a biopsy of the infected lymph node, X-ray of the affected areas and chest, and a tuberculin test are used.

Treatment includes antibiotics and surgery. To speed up recovery, lymphotropic therapy is used, which also helps to reduce the risk of relapse.

Due to age-related changes in the body of adolescents, their disease often takes on severe forms, such as infiltrative and disseminated.

Infiltrative tuberculosis

With this disease, accumulations of fluid with an admixture of blood are formed in the lungs. Symptoms are general - feeling unwell, decreased appetite, and fever. The diagnosis is made during an x-ray examination. It also reveals the type of accumulation and the area of the lesion.

Infiltrates are as follows:

• Bronchobular.
• Rounded.
• Cloudy.
• Labarny.

Treatment is carried out under the supervision of a doctor in a hospital with medications. In case of disintegration of the infiltrate and the threat to the patient's life, an operation is performed.

Disseminated tuberculosis

It is characterized by the presence of several lesions. It can be acute (miliary) and subacute. In the second case, there is a cough with blood, pain in the throat, a hoarse voice. Also, the disease can be chronic. It is accompanied by sputum, general weakness, difficulty breathing, fever, edema.

The outcome of treatment depends on the degree of damage. The earlier the disease was discovered, the faster the patient gets rid of it. The drugs are selected empirically, because the bacteria that cause the disseminated form are resistant to many types of drugs.

Diagnosis of tuberculosis in children

There are several ways to diagnose this disease, all of them are used with more or less popularity:

1. Tuberculin diagnostics. Tuberculin is an antigen of tuberculosis bacteria. It is injected in an amount of 0.1 ml under the skin and the reaction is monitored. After 3 days, the resulting papule is measured. Size up to 5 mm is considered the norm. Held once a year.
2. Fluorography. Modern fluorography is performed using digital equipment. The radiation dose is reduced to a minimum, and the image is obtained in the course of multi-layer imposition. This creates a snapshot that shows the lungs from all angles.
3. Radiography. If other methods have shown the presence of the disease, this procedure is prescribed. With its help, the following syndromes are revealed: focal shadow, lobar darkening, change in the size of the lung, round shadow syndrome, ring shadow syndrome, dissemination, change in the pattern and roots of the lung.
4. Bacteriological research. A popular diagnostic method abroad. For microscopy, a sputum smear is taken from the patient and stained with a fluorescent compound. The sowing of material is also carried out, which shows the presence of pathogens after 1-2 months from the onset of the disease.
5. Bronchoscopy. A sophisticated research method that gives the most accurate result. The taken material is subjected to this study in case of ineffectiveness of simpler methods.

Treatment of tuberculosis in children

Today, there are several methods of treating this disease that have a positive effect.

Chemotherapy

Allows you to achieve full recovery of the body and healing of foci of infections. The drugs used have a bacteriostatic and bactericidal effect. These include isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin.

For bacteria resistant to one or more drugs, there are specially designed agents such as kanamycin, amikacin, capriomycin, cycloserine, ethionamide, prothionamide, fluoroquinolones, paraaminosalicylic acid, rifabutin.

The right combination gives excellent results in the treatment of all types of disease. There are three-, four- and five-component treatment regimens.

The whole chemotherapy process is divided into 2 main stages:

1. Suppression of the growth of pathogenic bacteria and elimination of resistance.
2. Destruction of the remaining infection, which is located inside the cells and does not respond well to drugs.

Treatment lasts from six months to a year, depending on the severity and is canceled after a sputum test, which showed a positive dynamics of recovery.

DOTS strategy

A multi-level system that allows you to effectively fight the epidemic. Includes several activities:

• Bacterioscopic examination of patients.
• Use of suitable chemotherapy regimens under the guidance of experienced doctors.
• Provision of anti-tuberculosis drugs.
• Reporting and evaluation of results.

The system allows to reduce morbidity and mortality, as well as increase the number of recovered.

Surgical methods

Modern methods of surgical intervention are effective and safe for the patient.

Resection of the lungs is widely used. The following indications serve its purpose: Fibrous-cavernous lesion of the lungs, stenosis of the bronchi, progressive pulmonary tuberculomas, lung abscesses, pleural empyema, with ineffective drug treatment of caseous pneumonia.

Another surgical method is decortication. It is used to remove fibrous deposits. A cavernotomy is also used, as a result of which the opened cavity is cleaned.

Prevention of tuberculosis in children

For several years, BCG vaccination and prophylaxis with chemical drugs have remained the main methods of fighting infection. The first anti-tuberculosis vaccine, which produces immunity to the disease, is applied in the maternity hospital on the 3rd day after birth. The appearance of a scar indicates a past illness and the appearance of immunity. It will be fully formed by the first birthday.

Unfortunately, a number of contraindications have been identified that clearly prohibit the use of this method. They refer to children in whose family cases of immunodeficiency have been recorded, as well as severe complications that have arisen after vaccination in close relatives. You can not vaccinate people with a lack or deficiency of enzymes, severe genetic diseases, lesions of the central nervous system. Also, in some cases, it becomes necessary to transfer the procedure: infection, hemolytic diseases, prematurity.

On the subject: Prevention of tuberculosis in children and adults

To detect cases of infection, all children annually undergo a Mantoux test in a polyclinic or kindergarten. It is absolutely harmless as it does not contain viable bacteria.

All parents, without exception, are obliged to protect their child from illness and its dire consequences as far as possible. Systematic monitoring of health status and timely vaccination is sufficient. This disease must be prevented, not treated.

The author of the article: Makarova Evgenia Vladimirovna, pulmonologist