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D.Ghada Saad Abdelmotaleb Professor of Pediatrics

Tuberculosis. D.Ghada Saad Abdelmotaleb Professor of Pediatrics. Caused by mycobacterium tuberculosis , M. bovis [milk], mycobacterium africanum …etc **One case →infect 10-13 new case.

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D.Ghada Saad Abdelmotaleb Professor of Pediatrics

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  1. Tuberculosis D.GhadaSaadAbdelmotalebProfessor of Pediatrics

  2. Caused by mycobacterium tuberculosis , M. bovis [milk], mycobacterium africanum…etc **One case →infect 10-13 new case. • In developing countries WHO record >8 million case appeared each year and 3 million die. About 1/6of them are children . • 2 billion over the world infected cases due to [↓ resources-HIV/AIDS infection –crowded ] • It is acid fast bacilli→ need special stain and media to grow .

  3. Tuberculosis Maybe : • T.B. infection or tuberculosis disease ↓ ↓ • (+ve) tuberculin test (+ve) symptoms • No signs or radiologicalandfindings Signs or radiological

  4. Tuberculosis either ** Intra-thoracic or ** Extra-thoracic ↓ 1-1ry pulmonary T.B. { the common } 2-Reactive T.B. {adult} [no L.N.- has cavity- →infectious - may lead to sinus formation] 3-Tuberculous pleural effusion (need aspiration to diagnose).

  5. 1ry pulmonary T.B. In >98% lung is the portal entry It =(1ry pulmonary complex) consisted of: 1-Ghron’s focus 2-lymphagenitis 3-lymphadenitis - Usually asymptomatic or - Non specific manifestations [low grade fever- mild cough – malaise] ** In infant may lead to failure to thrive.

  6. Fate → Resolve (the majority) by fibrosis or calcification or ↓ Progressive pulmonary T.B.(rare but serious) give full blond picture with cavity . It may give : 1-Epi –tuberculosis→ direct spread to others lung parts. 2-Endo-trachial spread. 3-Lymphatic- hematogenous spread (disseminated disease) to liver- spleen- skin- joint-bones- kidney or meninges .

  7. Extra-thoracic T.B. **L.N. either→(partial) obstruction →hyperinflation ↓ (complete) atelectasis. the most common form. { L.N. are firm, discrete, not tender, fixed to under-laying tissue, usually unilateral .If progress it will matted together (mass) ,with low grade fever. It need excision biopsy}. **Miliary T.B. :{ 2 or more organs affected} more in infant and young children. ButTubercline test ( –ve) in 40% of cases.

  8. **T.B. abdomen. **C.N.S. the most serious - common in age 6m: 4years . ↓ Inflammation →obstruction (late) Or tuberculoma (mass) **Bone (Pott’s disease). **Others.

  9. MRI spine (Pott’s disease)

  10. Pott disease, also known as tuberculous spondylitis. Is one of the oldest demonstrated diseases of humankind, Tuberculosis of the spine in an Egyptian mummy

  11. Pediatric T.B. Is different from adult in several points: 1- The diagnosis is more difficult in children due to non specific or complete absence of symptoms . 2- Young children suffer more extra pulmonary and disseminated T.B. than adult.

  12. 3-Treatment of T.B. in children is challenging due to lack of pediatric drug formulations . 4- Young children are not contagious with active T.B. and acquired their disease from shared air space with adults with pulmonary T.B.

  13. Diagnosis

  14. 1- History : * Unexplained cough>3 weeks. *Haemoptysis. *Unexplained weight loss and fatigue. 2- Examination. 3- Very high ESR 4- Tuberculin test {delayed type hypersensitivity reaction}: Intra-dermal 0.1ml (5 tubercline unit) of purified protein derivative (PPD). **(+ve) ≥10mm. **False (–ve) in : - Malnutrition. - Poor technique or reading . - Immune- suppressive

  15. Tuberculin test

  16. 5-X-ray. ……… 6- Bacterial examination: *Zeil Nelson stain for sputum. *Gastric lavage and stain. * BACTEC ( 1:3 week use radiolabelad nutrients.) 7- Nucleic acid amplification ( NAA) e.g. PCR (polymerase chain reaction) . *Restriction fragment length polymorphism.

  17. Prevention : 1-Control of known cases. 2-Early diagnosis. 3- Increase resistance of population . 4-Chemoprophylaxis for contact.

  18. Treatment

  19. Other anti T.B. : • Cyclosporine • Kanamycine (IM) • Amikacin (IV) bacteriostatic to prevent drug resistance Steroids :1 mg / kg / day oral for 4 – 6 weeks. • In :1-T.B. meningitis . 2-Endo-tracheal . 3-Pericarditis .

  20. + Supportive treatment Duration ( regimen ) : • INH + RIF → 6 or 9 months + PZA 2 months • 12 months in CNS – BONES – disseminated disease • 4th drug SIM or EMP if INH resistance is present

  21. DOT ( Direct Observed Therapy ) • Twice / week by medical health care workers . • After two weeks with daily treatment .

  22. Thanks

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