Tuberculosis (TB) remains a formidable global health challenge, affecting individuals across all age groups. While often associated with adults, children are not immune to this infectious disease, presenting a unique set of challenges in terms of diagnosis, treatment, and prevention.
We spoke to Dr Gajendra Vikram Singh, Chairman, of UP State Task Force (NTEP), Professor and Head, of the Department of Respiratory Medicine, SN Medical College, Agra, who shared insights on the same.
According to Frontiers in Pediatrics, an estimated 2,10,000 youngsters die from TB every year. It is important to note that only 35% of children who have an active TB infection are properly identified and treated; in most low-resource nations, this percentage is far higher.
Prevalence and Incidence
“TB continues to be a significant public health concern worldwide, with an estimated one million new cases reported annually among children aged 0-14 years. Although the burden of the disease is higher in adults, children constitute a substantial portion of those affected”, said Dr Singh.
Transmission and Risk Factors
The transmission of TB occurs through the air, typically when an infected person coughs or sneezes. “Children face an elevated risk of contracting TB when living in close quarters with individuals who have active TB, especially in crowded or poorly ventilated environments.
Additionally, factors, such as malnutrition, HIV infection, and other immunocompromising conditions increase a child’s vulnerability to TB”, added Dr Singh.
Challenges in Diagnosis
Diagnosing TB in children poses a considerable challenge due to the nonspecific nature of symptoms. Symptoms often overlap with those of other common childhood illnesses, leading to delayed or missed diagnoses. Persistent cough, weight loss, fever, and fatigue are common presenting symptoms in children with TB.
Clinical Presentation
Dr Singh highlighted, “Children with TB may present with a variety of symptoms, and extrapulmonary TB (infection outside the lungs) is more prevalent in this population than in adults.
Organs, such as lymph nodes, bones, and the central nervous system can be affected, making the clinical presentation more diverse.”
Traditional TB diagnostic methods, such as sputum smear microscopy, may be less effective in children. To address this, molecular tests, chest X-rays, and tuberculin skin tests are commonly employed to aid in the diagnosis of paediatric TB.
Treatment Challenges
Paediatric TB necessitates a distinctive treatment approach, involving age-appropriate formulations of anti-TB medications. Adherence to a prolonged treatment regimen can be challenging for children and their caregivers, requiring additional support and resources.
Preventive Strategies
Dr Singh said, “Bacillus Calmette-Guérin (BCG) vaccination is a crucial component of routine immunisation in many countries and provides some protection against severe forms of TB in children. Early identification and treatment of latent TB infection in children with known exposure are essential to prevent the progression to active disease.”
Public Health Interventions
To effectively address paediatric TB, public health efforts should focus on reducing the overall burden of the disease. This involves improving living conditions, enhancing awareness among communities, healthcare providers, and parents, and integrating efforts into broader global strategies aimed at reducing the overall burden of TB.
Bottomline
Dr Singh concluded, “Tuberculosis in children presents unique challenges that require a comprehensive and multidisciplinary approach.
By increasing awareness, improving diagnostic tools, and developing child-friendly treatment regimens, we can make significant strides in addressing the impact of TB on the paediatric population.
Efforts to combat paediatric TB must be an integral part of the broader global strategy to control and eliminate this infectious disease.”