Talk about childhood tuberculosis

Tuberculosis is a serious disease that seriously endangers children's health. According to statistics, there were about 10 million new cases of tuberculosis in the world in 2018, and 1.49 million people died of the disease, including about 1.12 million cases of tuberculosis in children, and 200,000 deaths. There are nearly 800,000 tuberculosis patients reported in my country each year, but less than 10,000 of them are reported in children aged 0-14. Experts generally believe that many children with tuberculosis have not been discovered and treated in time, and the situation of tuberculosis in children in my country is seriously underestimated.

In order to let more people know and understand childhood tuberculosis, so that children with tuberculosis can be discovered as early as possible and receive timely treatment, today we will talk about childhood tuberculosis!

What is tuberculosis in children?

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, or TB for short. All organs of the body can be affected, but pulmonary tuberculosis is the most common. Childhood tuberculosis refers to tuberculosis in children aged 0-14 years old, mostly occurring in children under 5 years old, and 70%-80% of them are pulmonary tuberculosis.

How does tuberculosis occur in children?

1. The respiratory tract is the main route of transmission of tuberculosis. Children can become infected after inhaling droplets or dust containing Mycobacterium tuberculosis, forming primary lesions in the lungs. A few can also be infected through the digestive tract, forming primary lesions in the intestines.

2. The source of infection for tuberculosis in children is usually adults with tuberculosis in the family. Children may also be infected in public places such as schools.

3. 4-6 weeks after primary infection, children will develop a specific immune response. The immune response of most children can prevent the further reproduction and growth of Mycobacterium tuberculosis, which will become latent bacteria in the body; however, for children with low immunity, or children who carry Mycobacterium tuberculosis have low immunity, Mycobacterium tuberculosis will reproduce, thus inducing the occurrence of tuberculosis in children.

Note: Whether a child develops tuberculosis after being infected with tuberculosis depends on the virulence and quantity of tuberculosis bacteria, the strength of the body's resistance, and genetic factors. In addition, newborns are very susceptible to tuberculosis bacteria.

Clinical manifestations of tuberculosis in children

The clinical manifestations of tuberculosis in children vary greatly from person to person, and common symptoms include fever, cough, fatigue, night sweats, loss of appetite, and no or no weight gain. Mild cases may have no symptoms and can only be found during routine examinations. Severe cases mainly have symptoms of tuberculosis poisoning, with dry cough and mild dyspnea being the most common symptoms.

The symptoms of tuberculosis in children are difficult to distinguish from infectious diseases. Extrapulmonary tuberculosis is more common than in adults but is easily overlooked. In addition, young children mostly do not expectorate, and the detection rate of tuberculosis bacteria in sputum is low. Therefore, tuberculosis in children needs to be correctly diagnosed by tuberculosis specialists based on clinical experience, combined with laboratory tests, clinical manifestations, and other comprehensive analysis.

Drug treatment for tuberculosis in children

Drug treatment for tuberculosis in children should follow the principles of early, appropriate, combined, regular and full course. Currently, the first-line anti-tuberculosis drugs recommended by WHO for children include isoniazid, rifampicin, pyrazinamide and ethambutol, and the recommended dosages are as follows. Regarding drug dosage, WHO recommends that children under 5 years old use the upper limit of the recommended dosage, and adolescents and older children (weight up to 25 kg) use adult dosages for treatment.

Prevention of tuberculosis in children

The key to preventing tuberculosis in children is to protect them from infection with Mycobacterium tuberculosis. Specifically, the following points should be achieved:

1. The source of infection for children with tuberculosis is often from smear-positive adult tuberculosis patients in the family. Timely detection and complete cure of tuberculosis patients in the family is the key to preventing children from being infected with Mycobacterium tuberculosis.

2. BCG vaccination of newborns can improve resistance to tuberculosis and reduce the incidence of tuberculosis in children. However, the protective power of BCG is limited, and children who have been vaccinated with BCG should also pay attention to preventing infection with Mycobacterium tuberculosis.

3. Schools and homes should open windows regularly to keep indoor air fresh. According to statistics, 99% of tuberculosis bacteria in the air can be blown away after 4-5 ventilations for ten minutes each time.

4. Cultivate good hygiene habits for children, ensure adequate sleep, a balanced diet, strengthen physical exercise, and improve immunity.

In recent years, childhood tuberculosis has received more and more attention, and the country has also issued many guidelines to regulate and guide the treatment of childhood tuberculosis. Through today's popular science, I hope that more people will know and understand childhood tuberculosis, and I hope that children with tuberculosis can receive standardized treatment as soon as possible and grow up healthy and happy!

References:

[1] Gui Yonghao, Xue Xindong. Pediatrics 3rd Edition[M]. People's Medical Publishing House, 2018.

[2] Liu Eryong, Li Huimin, Zhao Shunying, et al. Epidemiology and diagnosis and treatment status of childhood tuberculosis[J]. Chinese Journal of Practical Pediatrics, 2018(6).

[3] Jiao Weiwei, Shen Adong. Current status and progress of drug treatment for tuberculosis in children[J]. Chinese Journal of Practical Pediatrics, 2020, 35(10):753-758.