Search Histology Slides


-------------------------------------------------------------------------------------------------------------------------------------------
  
Search Our Huge Database of Histo-Slides     


   

-------------------------------------------------------------------------------------------------------------------------------------------

Tuberculosis in Children Summarized






Tuberculosis

Evaluation

  • H/O Fever > 2weeks, weight loss, cough > 2 weeks, night sweats,
  • H/O contact with a case of tuberculosis (esp: family contact)
  • H/O measles, whooping cough or steroid intake in recent past
  • BCG vaccination status
  • Examination : malnutrition, unresolved pneumonia, pleural effusion, ascites, enlarged, matted lymph nodes, signs of meningeal irritation, focal neurologic signs
  • Blood complete exam, ESR
  • Radiograph chest : primary complex, hilar / mediastinal lymph node enlargement, effusion, miliary shadows.
  • Mantoux test 10mm or more at 72 hours
  • Accelerated BCG response 10 mm or more within 72 hrs
  • Pleural / abdominal aspirate : exudative with raised proteins , low sugar and cellular infiltrate with lymphocytic predominance
  • Lumbar puncture with CSF proteins > 40mg/dl, low sugar (< 50% blood sugar) and cellular infiltrate (> 5 WBC/mm3) with lymphocytic predominance
  • Gastric aspirate after overnight fast / Sputum for AFB
  • FNA and / or biopsy of lymph nodes



SCORING METHOD FOR DIAGNOSIS (Modified Kenneth Jones Criteria)

Features
1
2
3
4
5
Score
HISTORY





Age

<2 yrs
-
-
-
-
-
Close contact in last 2 years
With Sputum –ve TB patient

With sputum +ve TB patient



BCG scar

Absent
-




History of
measles and whooping cough
> 3months
<3 months




Immunocompromised/
Immunosuppressant*

Yes
-




PCM grade III
Yes
-
Not improving



EXAMINATION AND INVESTIGATION






Physical
examination

-
Suggestive of TB
*

Strongly suggestive
**


Radiological
Findings

Non specific
***
Suggestive of TB
****




Tuberculin skin
Test
5-10 mm

>10mm



Granuloma
Nonspecific



Specific for
TB

TOTAL SCORE



INTERPRETATION :
0 – 2 TB unlikely
3 – 4 Keep under observation
5 – 6 Tuberculosis probable, investigations may justify therapy
7 or more TB unquestionable
*consolidation not responding to antibiotic therapy
**pleural effusion / gibbus etc
***ill defined opacity / bronchovascular marking
****Paratracheal / mediastinal adenitis, miliary mottling

Management

  • Treat according to stage of disease
  • Stage I
No symptoms, No signs, only H/O contact, Chest X-ray negative, age below 3 years and/or h/o recent Mantoux positivity
INH 10 mg/kg/d + Rifampicin 15 mg/kg/d
Give for 6 months
·         Stage II
Patient symptomatic, Mantoux +, Chest X-ray Normal
INH 10 mg/kg/d + Rifampicin 15 mg/kg/d
Give for 9 months
·         Stage III
Patient symptomatic, Mantoux test +, Chest, abdominal, lymph nodes involvement
RIF+INH as above +Pyrazinamide 30 mg/kg/d after meals
Then withdraw PZI after 2 months and continue 2 drugs for total 9 months
·         Stage IV
TBM and Miliary TB
RIF, INH+PZA as above + Ethambutol 25 mg/kg/d 
Withdraw PZA and Ethambutol after 2 months and continue rest for one year.
Add Prednisolone(deltacortil) 2 mg/kg/d for 2-3 weeks.

No comments:

Post a Comment