Current Trends In The Management Of Childhood Tuberculosis

Abstract

EPIDEMIOLOGY About 30% of the world’s population is infected by the organism that causes tuberculosis. 8 to 10 million people develop the disease annually = 1000 new cases every hour. Of these, 11% occur in children <15yrs. Of the childhood cases, 75% occur annually in 22 high burden country that together account for 80% of the world’s incidence. About 2 million deaths occur annually which is equivalent to 52000 deaths weekly. Nigeria has the 5 largest TB burden worldwide. The FMOH declared TB a national emergency in April 2006. The world is presently witnessing resurgence in the incidence of TB. This may be attributable to worsening economic situation, multidrug resistance, the HIV pandemic, decline of national tuberculosis control programmes and large number of displaced persons living in poor conditions as a result of conflicts and wars. TB occurs at any age with the highest burden of disease found amongst children less than 4 years of age. Mode of spread is mainly by 1) inhalationcommonest; 2) ingestionthrough infected dairy products (this is rare) and 3) penetration of skin and mucous membranes (very rare). Children are infected from adult index cases with smear positive adults being 10 times more infective than smear negative cases. Manifestation of TB in children can be predicted based on the Walgreen Timetable highlighted below: Pulmonary tuberculosis – within a few months of primary infection. Miliary and meningeal tuberculosis – 2-6 months. TB adenitis 3-9 months. Bones and joints – several years. Renal and genital tuberculosis – may take over a decade. Pulmonary lesions occurring as a result of reactivation of a dormant focus previously established in the body takes a number of years after primary infection.