Slower diagnosis makes Tuberculosis hard to detect in kids

Hyderabad: Tuberculosis in children constitutes approximately six to seven per cent of the total tuberculosis burden in India, but childhood TB is under and also over-diagnosed and there are no child-friendly drug formulations. This poses a major challenge.

To make India free of TB by 2025, experts state that it is very important to look at the sector of childhood TB, which is highly neglected. The likelihood of children being infected is due to exposure to an infected person in the household.

If the infected person has sputum which is positive for pulmonary TB then it is important that children are kept away from the infected person, state experts as it is easy for them to get infected since their immunity is compromised.

Transmissions have also occurred in children when the sputum is negative, if the culture is positive for extra-pulmonary TB disease. 

Dr Ankit Parakh, consultant paediatric pulmonologist explained, “TB in children is a very critical issue and it continues to be neglected. This is because identifying TB in children is not very easy. Often when children report continuous fever, weight loss and persistent cough, they are given a dose of antibiotics. This makes diagnosis a challenge. While sputum is the diagnosis for adults, for children there is no sputum. Hence it requires a proper clinical evaluation of the history of the fever, weight loss and the other symptoms, to come to a conclusion.” 

Apart from clinical evaluation, chest X-Ray is very important to confirm TB. But experts state that since it is vague, there are times when it is over diagnosed and under diagnosed. Children are given a lot of antibiotics for fevers, cough, colds and respiratory illnesses and these add to the problem of making a clear diagnosis.

Dr C. Vijay Kumar, senior interventional pulmonologist at Apollo Hospitals explained, “Confirming TB in children continues to be a major challenge as we have to do endoscopy, lung biopsy and many other tests to come to a conclusion. Hence it poses a big challenge. As far as drug formulations are concerned, when we get a case of a child who is only two years old, we have to reduce the required dosages while treating the illness. Worldwide numbers showed that about one million children fell ill due to TB in 2016.” 

Seventy per cent of the children with TB have the disease in their lungs while the rest are affected by TB in other parts of the body. Children living in high TB endemic communities with people in the neighbourhoods having HIV/TB, contact with parents who are suffering from TB, low-nutrition foods, medically underserved populations and repeated exposure to germs are at a risk of catching TB.

Incidentally, there have been cases of TB even in affluent children, where they were found to be malnourished or exposed to people who had latent TB.