Tuberculosis, Lung Infections, and Respiratory Care

Pediatric Tuberculosis: Diagnosis and Management

Pediatric tuberculosis (TB) remains a major public health challenge, particularly in countries with high TB prevalence. Children are at greater risk of developing severe and disseminated forms of the disease due to their immature immune systems, making early diagnosis and appropriate management essential. Diagnosing TB in children is often difficult because symptoms are non-specific and obtaining sputum samples can be challenging. A thorough clinical assessment, including evaluation of exposure to an infectious adult, remains the cornerstone of diagnosis. Chest X-rays can reveal suggestive findings such as hilar lymphadenopathy, while immunological tests like the Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRAs) help detect infection, though they cannot distinguish between latent and active disease. Molecular tools such as GeneXpert MTB/RIF Ultra have significantly improved diagnostic accuracy by rapidly detecting Mycobacterium tuberculosis and rifampicin resistance from various specimen types, including gastric aspirates and stool samples.

Management of pediatric TB follows the same principles as adult treatment but is tailored to a child’s weight, age, and disease severity. Drug-susceptible TB is treated with a six-month regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol in the intensive phase, followed by isoniazid and rifampicin in the continuation phase. Child-friendly fixed-dose formulations have improved dosing accuracy and treatment adherence. In cases of drug-resistant TB, newer all-oral regimens that include bedaquiline, linezolid, and levofloxacin are now preferred to minimize toxicity and improve outcomes. Supportive care—including nutritional supplementation, management of coexisting conditions such as HIV, and regular monitoring—is vital to successful recovery. Preventive therapy for children exposed to infectious TB cases, particularly those under five years or immunocompromised, plays a crucial role in reducing disease transmission and progression.