How to manage TB in children? Problems and solutions in four cases

Danilo Buonsenso 1 , Daniele Serranti 1 , Benedetta Focarelli 1 , Antonio Chiaretti 1 , Roberta Calzedda 1 , and Piero Valentini 1
  • 1 Catholic University of Sacred Heart, Rome, Italy


Children bear a substantial part of the tuberculosis (TB) epidemic worldwide, and it is estimated that there were ≅ 500.000 childhood TB cases globally in 2010, although accurate data are problematic to obtain given the many difficulties associated with TB diagnosis in children and the weaknesses of surveillance systems in countries where TB is endemic. The World Health Organization is working hard in order to reduce the TB prevalence rates and deaths by half by 2015. In this challenge, general practitioners and pediatricians play a key role in detecting early cases of suspected TB and sending them to experts in infectious diseases. This will reduce delayed diagnosis and the spread of disease, which is especially important now that the prevalence of multidrug resistant TB is increasing. For this reason, the purpose of this report was to delineate the characteristic clinical features of the most common forms of pediatric TB and to suggest a rational and practical approach to the disease underlining the role of patients and parents personal and clinical history.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • [1] World Health Organization. Global Tuberculosis Control: WHO Report 2011. Geneva, Switzerland: World Health Organization; 2011. Publication WHO/HTM/TB/2011.16

  • [2] Getahun H., Sculier D., Sismanidis C., Grzemska M., Raviglione M., Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services, J. Infect. Dis., 2012, 205, Suppl 2, 216-S227

  • [3] Merino J.M., Carpintero I., Alvarez T., Rodrigo J., Sanchez J., Coello J.M., Tuberculous pleural effusion in children, Chest 1999, 115, 26-30

  • [4] Starke J.R., Jacobs R.F., Jeber J., Resurgence of tuberculosis in children, J. Pediatr., 1992, 120, 839

  • [5] Bayazit N., Namiduru M., Mycobacterial cervical lymphadenitis, ORL. J. Otorhinolaryngol. Relat. Spec., 2004, 66, 275-280

  • [6] Papadopouli E., Michailidi E., Papadopoulou E., Paspalaki P., Vlahakis I., Kalmanti M., Cervical lymphadenopathy in childhood epidemiology and management, Pediatric Hematol. and Oncol., 2009, 26, 454-460

  • [7] van Well G.T., Paes B.F., Terwee C.B., Springer P., Roord J.J., Donald P.R., et al., Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa, Pediatrics 2009, 123, e1-8

  • [8] Prasad K., Singh M.B., Corticosteroids for managing tuberculous meningitis, Cochrane Database Syst. Rev., 2006, CD002244

  • [9] Shah I., Steroid therapy in children with tuberculous meningitis, Scand. J. Infect. Dis., 2009, 41, 532-534

  • [10] Buonsenso D., Serranti D., Valentini P., Management of central nervous system tuberculosis in children: light and shade, Eur. Rev. Med. Pharmacol. Sci., 2010, 14, 845-853

  • [11] Van der Merwe D.J., Andronikou S., Van Toorn R., Pienaar M., Brainstem ischemic lesions on MRI in children with tuberculous meningitis: with diffusion weighted confirmation. Childs Nerv. Syst., 2009, 25, 949-954

  • [12] Chintu C., Tuberculosis and human immunodeficiency virus co-infection in children: management challenges, Paediatr. Respir. Rev., 2007, 8, 142-147

  • [13] Pillay T., Khan M., Moodley J., Adhikari M., Coovadia H., Perinatal tuberculosis and HIV-1: considerations for resourcelimited settings, Lancet Infect. Dis., 2004, 4, 155-165

  • [14] Ahmed Y., Mwaba P., Chintu C., Grange J.M., Ustianowski A., Zumla A., A study of maternal mortality at the University Teaching Hospital, Lusaka, Zambia: the emergence of tuberculosis as a major non-obstetric cause of maternal death, Int. J. Tuberc. Lung. Dis., 1999, 3, 675-680

  • [15] Vilarinho L.C., Congenital tuberculosis: a case report, Braz. J. Infect. Dis., 2006, 10, 368-70.

  • [16] Singh M., Kothur K., Dayal D., Kusuma S., Perinatal tuberculosis a case series, J. Trop. Pediatr., 2007, 53, 135-138

  • [17] Blussé van Oud-Alblas H.J., van Vliet M.E., Kimpen J.L., de Villiers G.S., Schaaf H.S., Donald P.R., Human immunodeficiency virus infection in children hospitalised with tuberculosis, Ann. Trop. Paediatr., 2002, 22, 115–123

  • [18] Schaaf H.S., Beyers N., Gie R.P., Nel E.D., Smuts N.A., Scøtt F.E., et al., Respiratory tuberculosis in childhood: the diagnostic value of clinical features and special investigations, Pediatr. Infect. Dis. J., 1995, 14, 189-194

  • [19] Pillay T., Sturm A.W., Khan M. et al., Vertical transmission of Mycobacterium tuberculosis in Kwa Zulu Natal. Impact of HIV-1 co-infection, Int. J. Tuberc. Lung. Dis., 2004, 8, 59–69

  • [20] Cantewel M.F., Shehad Z.M., Castelo A.M., Adhikari M., Moodley J., Connolly C., et al., Brief report: congenital tuberculosis. N. Engl. J. Med., 1994, 14, 1051-1054

  • [21] Palme I.B., Gudetta B., Bruchfeld J., Muhe L., Giesecke J., Impact of human immunodeficiency virus 1 infection on clinical presentation, treatment outcome and survival in a cohort of Ethiopian children with tuberculosis, Pediatr. Infect. Dis. J., 2002, 21, 1053-1061

  • [22] Kaufmann S.H., Ladel C.H., Role of T cell subsets in immunity against intracellular bacteria: experimental infections of knock-out mice with Listeria monocytogenes and Mycobacterium bovis BCG, Immunobiology, 1994, 191, 509-519

  • [23] Rekha B., Swaminathan S., Childhood tuberculosis–global epidemiology and the impact of HIV, Paediatr. Respir. Rev., 2007, 8, 99-106

  • [24] Buonsenso D., Valentini P., Pediatric Tuberculosis: treatment strategies. In book: treatment strategies: pediatrics, 2013, 11-57-63

  • [25] Buonsenso D., Pirronti T., Gargiullo L., Ranno O., Valentini P., Side effects of the immune system: lessons from tuberculosisrelated immune reconstitution inflammatory syndrome, Eur. J. Inflam., 2012, 10, 1-10

  • [26] Chegou N.N., Black F.B., Kidd M., van Helden P.D., Walzl G., Host markers in Quantiferon supernatants differentiate active TB from latent TB infection: preliminary report, BMC. Pulm. Med., 2009, 16, 9-21

  • [27] Duarte R., Tavares E., Miranda A., Carvalho A., Tuberculosis in a child–search for the infected adult nearby; case report, Portugal, 2007, Euro Surveill., 2009, 10, 14

  • [28] Buonsenso D., Lancella L., Delogu G., Krzysztofiak A., Testa A., Ranno O., et al., A twenty-year retrospective study of pediatric tuberculosis in two tertiary hospitals in Rome, Pediatr. Infect. Dis. J., 2012, 31, 1022-1026


Journal + Issues