Updates on the Diagnosis and Treatment of Childhood Tuberculosis

1. Updates on the Diagnosis and Treatment of Childhood Tuberculosis Andrea T. Cruz, M.D., M.P.H. Assistant Professor of Pediatrics Sections of Emergency Medicine & Infectious Disease

2. Objectives Objectives: How and whom to screen for TB risk factors Know the most common radiographic findings for childhood TB Differences between skin tests and interferon gamma release assays (IGRAs) Utilization of IGRAs Limitations of skin tests and IGRAs Rationale for chemoprophylaxis for children with TB exposure and infection

3. Definitions TB exposure: a young child (< 4 y.o.) with a negative PPD or interferon gamma release assay (IGRA), negative CXR, and normal exam who has been in contact with an adult with contagious TB (Latent) TB infection (LTBI): positive TST or IGRA in a child with a negative CXR and normal physical examination TB disease: a positive culture for TB or combination of at least 2 of the following: Epidemiological link to a suspected source case Positive PPD or IGRA Abnormal chest radiograph (or other imaging) The CDC/AAP defines TB exposure as a person with a negative tuberculin skin test (TST), a normal chest radiograph, and a normal physical examination who has been in contact with an adult with TB. Functionally, this category is useful for preschool aged children, where chemoprophylaxis is recommended during the window period between exposure and reading the definitive TST. TB infection (LTBI) is defined as a positive TST in a child with a negative CXR and normal physical examination. TB disease is defined either as a positive culture for M. tb or, for culture-negative patients, a combination of an epidemiologic link with a suspected source case, a positive TST, an abnormal CXR (or other relevant imaging studies such as CT head/MRI for children with suspected TBM with basilar enhancement); or signs/symptoms compatible with pulmonary or extrapulmonary TB. Many of the children diagnosed were identified in the course of contact investigation and were asymptomatic at time of diagnosis, and how this differs from what is seen abroad – difference between active and passive surveillance. So many of the international studies cannot be generalized to more economically developed nations. The CDC/AAP defines TB exposure as a person with a negative tuberculin skin test (TST), a normal chest radiograph, and a normal physical examination who has been in contact with an adult with TB. Functionally, this category is useful for preschool aged children, where chemoprophylaxis is recommended during the window period between exposure and reading the definitive TST. TB infection (LTBI) is defined as a positive TST in a child with a negative CXR and normal physical examination. TB disease is defined either as a positive culture for M. tb or, for culture-negative patients, a combination of an epidemiologic link with a suspected source case, a positive TST, an abnormal CXR (or other relevant imaging studies such as CT head/MRI for children with suspected TBM with basilar enhancement); or signs/symptoms compatible with pulmonary or extrapulmonary TB. Many of the children diagnosed were identified in the course of contact investigation and were asymptomatic at time of diagnosis, and how this differs from what is seen abroad – difference between active and passive surveillance. So many of the international studies cannot be generalized to more economically developed nations.

4. Famous People with TB JFK* Eleanor Roosevelt Nelson Mandela Simon Bolivar King Tut Bronte (x3) Fyodor Dostoyevsky Henry David Thoreau Ralph Waldo Emerson Franz Kafka John Keats Edgar Allan Poe R.L. Stevenson Frederic Chopin