What is tuberculosis?
Tuberculosis (TB) is an airborne infection that primarily affects the lungs.
Who is at risk
While TB is less common than it once was, some groups of children have a higher risk of developing tuberculosis, including:
Children living in a household with an adult who has active tuberculosis or has a high risk of contracting TB
Children infected with HIV or another condition that weakens the immune system
Children born in a country that has a high prevalence of TB
Children visiting a country where TB is endemic and who have extended contact with people who live there
Children from communities that generally receive inadequate medical care
Children living in a shelter or living with someone who has been in jail
How it is spread
Tuberculosis usually is spread when an infected adult coughs the bacteria into the air. These germs are inhaled by the child, who then becomes infected. Children younger than about ten years old with TB of the lungs rarely infect other people, because they tend to have very few bacteria in their mucus secretions and also have a relatively ineffective cough.
Fortunately, most children exposed to tuberculosis don't become ill. When the bacteria reach their lungs, the body's immune system attacks them and prevents further spread. These children have developed a symptom-free infection indicated only by a positive skin test. However, the symptom-free child still must be treated to prevent an active disease from ever occurring.
Occasionally, in a small number of children without proper treatment, the infection does progress, causing fever, fatigue, irritability, a persistent cough, weakness, heavy and fast breathing, night sweats, swollen glands, weight loss, and poor growth.
In a very small number of children (mostly those less than four years old), the tuberculosis infection can spread through the bloodstream, affecting virtually any organ in the body. This illness requires much more complicated treatment, and the earlier it is started, the better the outcome. These youngsters have a much greater risk of developing tuberculosis meningitis, a dangerous form of the disease that affects the brain and central nervous system.
Children who are at risk for contracting TB should receive a tuberculin skin test (sometimes called a PPD (purified protein derivative off tuberculin). Your child may need a skin test if you answer yes to at least one of the following questions:
Has a family member or contact had tuberculosis disease?
Has a family member had a positive tuberulin skin test?
Was your child born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)?
Has your child traveled (had contact with resident populations) to a high-risk country for more than one week?
The test is performed in your pediatrician's office by injecting a purified, inactive piece of TB germ into the skin of the forearm. If there has been an infection, your child's skin will swell and redden at the injection site. Your pediatrician will check the skin forty-eight to seventy-two hours after the injection, and measure the diameter of the reaction. This skin test will reveal past infection by the bacteria, even if the child has had no symptoms and even if his body has fought the disease successfully.
If your child's skin test for TB turns positive, a chest X-ray will be ordered to determine if there is evidence of active or past infection in the lungs. If the X-ray does indicate the possibility of active infection, the pediatrician also will search for the TB bacteria in your child's cough secretions or in his stomach. This is done in order to determine the type of treatment.
If your child's skin test turns positive, but he does not have symptoms or signs of active tuberculosis infection, he still is infected. In order to prevent the infection from becoming active, your pediatrician will prescribe a medication called isoniazid (INH). This medication must be taken by mouth once a day every day for a minimum of nine months.
For an active tuberculosis infection, your pediatrician will prescribe three or four medications. You will have to give these to your child for six to twelve months. Your youngster may have to be hospitalized initially for the treatment to be started, although most of it can be carried out at home.
Controlling the spread of TB
If your child has been infected with TB, regardless of whether he develops symptoms, it's very important to attempt to identify the person from whom he caught the disease. Usually this is done by looking for symptoms of TB in everyone who came in close contact with him, and having TB skin tests performed on all family members, babysitters, and housekeepers; the most common symptom in adults is a persistent cough, especially one that is associated with coughing up blood. Anyone who has a positive skin test should receive a physical examination, a chest X-ray and treatment.
When an active infection is found in an adult, he will be isolated as much as possible–especially from young children–until treatment is under way. All family members who have been in contact with that person usually are also treated with INH, regardless of the results of their own skin tests. Anyone who becomes ill or develops an abnormality on a chest X-ray should be treated as an active case of tuberculosis.
Tuberculosis is much more common in underprivileged populations, which are more susceptible to disease due to crowded living conditions, poor nutrition, and the probability of inadequate medical care. AIDS patients, too, are at a greater risk of getting TB, because of their lowered resistance.
If untreated, tuberculosis can lie dormant for many years, only to surface during adolescence, pregnancy, or later adulthood. At that time, not only can the individual become quite ill, but he also can spread the infection to those around him. Thus, it's very important to have your child tested for TB if he comes in close contact with any adult who has the disease and to get prompt and adequate treatment for him if he tests positive.