Tuberculosis in Children

Tuberculosis can be a potentially fatal disease if not properly treated.

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Overview

A contagious disease, tuberculosis, or TB for short, is a public health issue that requires active tracing of contacts. Read on to find out more about TB in children. 

Causes of TB in Children


TB is caused by certain germs (bacteria) known as Mycobacterium tuberculosis.

It is spread in the air via small airborne droplets that are usually produced when someone who is sick with TB coughs, laughs, sings, or sneezes. Anyone who breathes in the TB germs can get infected. The chances of your child being infected with TB depends on several factors, like how infectious the sick person is, whether he/she covers his/her mouth and nose when coughing, how close and how long your child was in contact with the sick person, and whether the sick person has been treated adequately with anti-TB medications.

Generally speaking, approximately 30 to 40 percent of close contacts (typically household members, although schoolmates and colleagues can be affected as well) of a person with infectious TB become infected with TB. However, children with TB are usually much less infectious compared to adolescents or adults. Your child cannot become infected by simply sharing washed drinking containers or eating utensils, or by touching or hugging infected persons.

Symptoms of TB in Children


When your child breathes in air that contains TB germs, he/she may get a “silent” TB infection (also known as Latent TB Infection or LTBI). This means that the immune defence of your child’s body has kept the offending germs under control, and he/she has dormant (or sleeping) TB bacteria. LTBI does not make your child sick and cannot be passed to anyone else. Patients with LTBI do not have any symptoms.

However, if the child’s body does not keep the TB germs under control, particularly (though not always) if he/she has other health problems, for example HIV infection and diabetes, etc., then these dormant TB germs could “wake up” and multiply. The child will then become sick with active TB (or TB Disease). This usually happens in the first two years after infection.

TB usually affects the lungs. Patients with TB Disease may complain of a persistent cough (the sputum may be blood-stained or he/she may actually cough up blood), fever, night sweats, weight loss, loss of appetite, and getting tired easily. However, it can also affect other parts of the body, such as lymph nodes, bones, joints, kidneys, intestines, skin, brain, liver, and the coverings of the heart. As such, the symptoms of TB Disease can be very variable depending on the organ(s) affected. Patients with TB Disease can pass the germs to other people.

Risk Factors


Children with health problems such as HIV infection or diabetes.

Younger children (especially those five years and below) also have an increased risk of getting active TB when they are infected, as their bodies are usually less capable of keeping the TB bacteria under control.

Prevention 

Severe forms of TB in infancy (such as TB in the brain or widespread TB in the body) may be prevented by the bacillie Calmette-Guerin (BCG) vaccine, but it is not 100-percent effective and cannot prevent other forms of TB (such as that in the lungs) and cannot prevent TB later in life. 

On a personal level, if you have TB, you should seek and adhere to active treatment, and practice self-quarantine for the short duration advised by your doctor. On a community level, we should actively identify and help TB sufferers get access to appropriate treatment and adhere to quarantine measures.

Diagnosis of TB in a Child


Children who are suspected of having TB may be required to be hospitalised initially for the necessary tests and treatment to be performed.

The presence of symptoms may suggest TB, but they cannot be used to confirm TB. Furthermore, patients with Latent TB Infection do not have any symptoms. Your child’s doctor will need to obtain the relevant history and perform a detailed physical examination. 

Depending on the clinical information available, the doctor may perform certain tests such as a TB skin test, blood tests, chest X-ray, and sputum or early-morning gastric (stomach) fluid tests. Other tests may be ordered depending on the child’s symptoms, and consultation will be made with attending Infectious Disease Consultants. 

Some of these tests, especially those that attempt to culture or grow TB germs, may take up to two months to be ready. Therefore in some cases, the  doctor may advise presumptive treatment based on a combination of suggestive symptoms, signs and/or test results.

TB in Children: Treatment Options


Latent TB Infection usually requires the patient to take one to two types of medication for up to nine months to control the bacteria. The medicine needs to be taken to prevent getting active TB disease.

Active TB Disease will require the patient to take three or more medication for at least six months depending on the type and severity of TB Disease. The treatment is very effective in curing TB as long as your child takes the medication. You need to ensure your child swallows the medicines and completes the whole course. Even if your child feels better, he/she will need to stay on the medicine to be fully cured. Any interruptions in treatment may need the whole course to be restarted depending on when and how long the interruption was. TB germs die very slowly and the treatment takes months to be effective. Taking medication according to the way they are meant to be taken is the only way to ensure your child’s TB is cured.

Possible Complications Due to TB Medication


While side effects due to the medication can occur, they are uncommon in adults and much less common in children. 

Complications arise mainly due to liver inflammation and are reversible upon stopping the medications. If you have any concerns about your child’s medications, feel free to discuss them with your child’s doctor. The good news is that most people can take their TB medicines without any problems.

One other common reaction for patients on rifampicin is having a reddish-orange discoloration of urine, faeces and tears, which is normally expected.

If your child is being treated for TB, inform your doctor immediately if he/she has: 
A fever
A rash
Aching joints
Aches or a tingling sensation in their fingers and/or toes
An upset stomach, nausea, or stomach cramps/discomfort
Decreased or no appetite for food
Vomiting
Changes in eyesight, such as blurred vision
Changes in hearing, such as ringing in their ears
Dizziness
Bruising or easy bleeding with cuts
Tingling or numbness around the mouth
Yellow skin or eyes

Where to Seek Treatment for TB in Children


The medical institutions within SingHealth that offer consultation and treatment for this condition include: 


KK Women's and Children's Hospital

Children's Services — Infectious Diseases
100 Bukit Timah Road Singapore 229899 


Appointment Hotline:
Tel: +65 6294 4050

International Enquiries, please contact:
Tel: +65 6394 8888
Email: international@kkh.com.sg


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