Should primary tuberculosis in childrencontinue to be neglected

Abstract

Summary Primary tuberculosis is the fountainhead of tuberculous diseases. When acquired during childhood, it may develop into serious tuberculous diseases within a short period of time, or it may remain latent during childhood only to become reactivated in adult life, giving rise to such condition as chronic pulmonary tuberculosis. Until recently, little could be done to control the natural consequences of primary tuberculosis. As a result, large numbers of infected children and adults continue to fall ill with tuberculosis. The discovery of isoniazid had opened a new hope. Animal experiments have brought forth convincing evidences that isoniazid is effective in controlling primary tuberculosis, even in its progressive form. Clinical experiences strongly indicate that serious tuberculous diseases can be prevented in infected children by the early institution of isoniazid therapy. Since its use three years ago, there has been a sharp decline in the incidence of tuberculous meningitis and miliary tuberculosis in children. Now that primary tuberculosis canbe treated, it is more than ever a regret that a child be allowed to develop serious tuberculous diseases. Pediatricians and public health officers must assume their new responsibility of recognizing primary tuberculosis and make available to infected children the benefit of modern drug therapy. There is no other means which can detect primary tuberculosis as early and as accurately as a simple tuberculin test. For this reason, tuberculin testing must be made a routine pediatric procedure in well-baby clinics, nurseries, and schools, as well as in children's clinics and in private practice. One of the greatest pediatric triumphs in the United States is the conquer of congenital syphilis in the current generation. This was accomplished by public education, universal serologic tests and vigorous drug therapy of the syphilitic pregnant mothers. Today the principle of tuberculosis control should be universal tuberculin testing and vigorous drug therapy of tuberculosis in children and adults. There is yet much to be learned about primary tuberculosis and isoniazid therapy. Most likely, newer and better drugs will be discovered. From now on a large share of the responsibility of tuberculosis control will fall on the shoulders of pediatricians. Primary tuberculosis can no longer be neglected.