Pulmonary tuberculosis in pediatric practice

Abstract

COVID-19 pandemic caused a decline in health care quality of patients with tuberculosis. Although the number of reported new tuberculosis cases has fell during the pandemic, the number of dead from the disease has increased as has the number of estimated disease cases. Lung tuberculosis in children has, therefore, remained a medical challenge and serious health care problem. The most important part of the diagnostic process is detailed patient history regarding the characteristics of the source index patient, characteristic and types of contact with the index patient and the age and immunologic characteristics of the child. Typical symptoms are evident in older children, while younger children can be asymptomatic. Also, radiological pulmonary examination is specific in the adolescent age group, while in the younger children it can present uncharacteristic changes. Interferon gamma releasing assay is used to detect Mycobacterium tuberculosis infection. It is a well established quick and sensitive blood test which determines an immunological reaction to the Mycobacterium tuberculosis. Microbiologic examination of the sputum or gastric lavates by microscopy and cultures is paramount in the diagnostic examination, but is also less reliable in younger children. Therapy in children involves prophylactic therapy of the tuberculosis infection which prevents progression of the infection to the active pulmonary tuberculotic disease. Full antituber-culotic therapy is used when active tuberculosis has been diagnosed. Diagnostic examination and therapy is supervised by pediatric pulmologist in cooperation with primary health pediatrician and epidemiologist with the aim of early diagnosis of latent or active disease and early implementation of therapy to cure the disease.