Tuberculosis in Children

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Tuberculosis in Children

• ?????? ??????
• ?????????????????????

2
?????

• ?????????????????????? ???????????????????????????
  ??
• ????????????????????????????????
  ??????????????????????
• ??????????????????????????????? ????????????
• ??????????????????????????????????????????????????
  ??????????? ??????????????????????????????????????
  ???????
• ??????????????????????????????????????????????????
  
• ????????????????????????? (cavity)

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???????????????????????

• ??????????????????????????????????????????????????
  ???????????????????????????
• ??????????????????????????????????????????????????
  ??
• ????? source case ????????????????????????????????
  ????

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?????????????????????????????????????
????????? ??????? Pulmonary TB ?????? lt 15 ??
(2527 2550)
?????
?? ?.?.
??????????? ??????????????? ????????????
????????????????
5
????????? ??????? TB Meningitis ?????? lt 15 ??
(2527 2550)
?????
?? ?.?.
??????????? ??????????????? ????????????
????????????????
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Pathogenesis of Tuberculosis
Inhalation of M.tb
Implantation at alveoli
4-8 wk.
DTH TTve CMI
Multiplication of M.tb
Lymphohematogenous spreading
Favorable to growth (eg. Upper lung, cerebral
cortex, kindney
Unfavorable to growth (eg. BM, liver, spleen
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Favorable to growth - Lung
Complete resolution healing Primary TB
(rare) (eg.pulmonary dissemination)
stable for years Post primary
TB (adult type), extra pulm.TB
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Clinical forms of Childhood TB

• Pulmonary majority (70-80)
• Extrapulmonary - minority (20-30)
• - TB Lymphnocle
• - TB meningitis
• - TB bone and joints
• - TB abdomen
• - TB skin

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Risk of Development TB Disease from TB infection

• Infant lt 1 yr. 40-50 in first 2 yr.
• Children 10-15 in first 2 yr.
• Adult 5 lifetime

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Diagnosis
1. ????????????????????

• ??????????????????????????????????????????????
  ???????????? 2 ???
• 1.1 ??????????????????????????????
• 1.2 TT gt10 ??. (?? immunodef. ??? gt 5 ??.,
• ??? gt 15 ??. ?????????????
• 1.3 ?????????????????????????????????????????????
  ???????
• ??????????????????? 1.1 1.2 1.3

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2. ??????????????????????????????????

• ???????????? ?????????
• ????????????????
• ?????????????????????
• ???????????????, antigen-antibody, PCR,
  ???????????????????? IFN? (Quantiferon TB
  gold, Elli spot)

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????????????????? ????????????????????????

• ????????? (Pulmonary TB) ????????????????????
  ???? ?????? ? ???????? ?????????? ?????????????
  ????????????? ???? ?????????? ?????????? ???
  ?????????

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• ???????????? (Extra pulmonary TB)
  ?????????????????????????????

• ??????????????????? ?????????? increased ICP
  CSF ????????????? (Protein ???, Sugar ???, cell
  ???????? 1000/cu mm ???? Lymphocytes)
• ??????????????????? ?????????? ?????? ?????????
• ?????????????????? ?????????????
  ?????????????????????? ??????? etc.
• ???????????? ???????????????????????
• ???????? ???? hematuria Sterile
• ?????? military ??????????? ?????? ??? ???

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Tuberculin Test

• ????????????? immunity ???? extent of TB ???????
  infection
• TT gt 15 mm.
• ??????????????????? - ????????????? ??????????
  Rx
• ???????????????? ??? Rx LTBI (H 6-9 ?????)
• 10 of culture proven TB ?? negative
• TBN, Milary TB ??? negative
• ?????????????????????, HIV, ??? steroid ?????????
  TB ??? TT negative
• ??????????? ?????????????????????? BCG,
  ??????????? Atypical TB

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??????????????????????????????????????????????????
BCG ???????????

• 30-50 ?? dia gt 5 mm.
• 10-20 ?? dia gt10 mm. ????????? 2528, 2541
• 8 ?? dia gt 15 mm.

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Treatment

• ???????????????????????????????????
• ??????? intermittent regimen
• ?????? Ethambutol ??????????????? 20 ??./??./???
• ????????????? ??????? DOTS

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?????? ?? 3 categories

• Cat I 2HRZE / 4HR ?????
• ?????????????????????????????
• ???????????????????????????????? ????? extensive
  lesion
• ???????????????????????? ????? 9 ?????
• ?? TBM ?????? S ??? E

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• Cat II 2HRZES / 1HRZE / 5HRE ?????
• ????????????????????????????? ????????????????????
  ???? ???????????? 2 ????? ????????????? 5
  ???????????????
• ???????????????????????????????????

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• Cat III 2HRZ(E) / 4HR (????? E ?????
• ?????????????????????) ?????
• ???????????????????????????????????? ?????????
  cavity ?????
• ?????????????????????????

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??????????

• ????????? ? ?????????? 1-2 ???????
• 80 ??????????????? 3 ?????
• 90 ???????????? 4 ?????
• ????????????????????? 10-12 ?????
• ????????????? 6 ????? ????????????????????????
  ?????????????????????????????
• ??????????????? ?????????? 2-3 ?? ???????
• ??????????????????????????
• ???????????????? relapse ???????? 1

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??????????

• ??????????? ??? ?????????????????????
  ???????????????????????????? ?????????????????????
  ?????? ????????????????????????
• ?????????????????????
• ?????????????????????????????????????????????????
  ???????????????????????????????? (Rx TBI)

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???????????? ??????

• ????????????????????? 50
• ?????????????????????????? 64
• ??????????????????????????? 78
• ???????????????????????? TB prevalence gt
  40/100,000/??
• (?????????????????? 83/100,000 ????? ??
  ?.?.2535
• 62/100,000 ????? ??
  ?.?.2549

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????????????????????? ??????????????????????? (Rx
LTBI)

• ???????????????????? 2 ????? ??? retrospection
  ?.?.2538 2540, 2542-2543 ????? ?????????? BCG
  ??????????????????????????????????????????????????
  ????? ?????????? 9.1 ??? 8.2
• ???????????????????? ?.?.2547-49 ??? prospective
  ????? ?????????? BCG ?????????????????????????????
  ?????????????????????????? ?????????? 1.64
  ?????????????? 6.4
• ????????????????????? ????? ?????????? 1
  ?????????????? 20-30
• ????????????????????????????????????? ???????????
  ????????????????????? 90 ????????????????????????
  ????? 19 ??

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????????????? Rx LTBI

• ??????????????????????????????????????????????????
  ?????? ????????????????????????????
  ??????????????????????????????
  ????????????????????????????????
  ?????????????????????????????? ??????
• ???? lt 5 ?? ??? H 5-10 ??./??? 6-9 ?????
• ???? gt 5 ?? ??? TT gt 15 ??.??? H 5-10 ??./??? 6-9
  ????? (??? 10-14 ??. ????????????????? ? ?? ???
  TT lt 10 ??. ???????????? ??????????????????
• ???????????? HIV ?????? ??? H 9 ?????

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????????????????????????????????
????????????????????????????????????????
Rx, DOTS
??????????????????????
???????????, ???????????????, ????????????????????
?????
??????????
Rx, DOTS
?????????????
???? lt 5 ?? Rx H 6-9 ?????
???? gt 5 ?? Rx ??? TT gt 15 ??. H 6-9 ????? Rx
??? TT gt 10-14 ??. ?????????????? ? ?? ???????
??????????????????
????????????????? HIV Rx- H 9 ?????
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????????????????????????????????
?????????????????????????????????? ??????????

• ???? lt 5 ?? ??? TT gt 15 ??.
• ??????????????????, ???????? HIV, ??? steroid
• ?? old fribrotic lesion ??????????????
• Recent converter

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TB Elimination

• ??????????????????????????????????????
  ??????? ???????????
• ?? contact investigation, ??????????????????????
  ???????????????? (Rx LTBI)
• ?????????????????????????????????
  ??????????????????????

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Thank you