By Tedler D. Depaynos, MD
Tuberculosis or TB in children below 5 years old is called Primary Complex.
During our younger days when we basically practiced as a family physician we gave this impression to children who have non-specific body malaise, anorexia, night or evening low grade fever or sweating and failure to thrive or are losing weight without any reason. No signs of obvious infection could be found clinically and because of the high incidence of Tuberculosis (TB) during that time, the impression was routinely given.
With the aggressive health program of the Department of Health, the incidence of TB successfully went down. Recently, however, there seems to be a resurgence which is even being bannered in our social media so that once again a review is needed.
Presently we always now refer our pediatric patients to our younger Pediatric Specialists who are well versed on the present common or rare diseases we now encounter and their current diagnostic procedures and treatment.
From Dra. Corazon “Pinky” Lopez, a well known pediatrician, we had a rare review of TB especially in children.
Tuberculosis is basically spread by droplets. It may be due to sneezing, coughing and even talking. It is said that more droplets are spread by coughing (5 million bacteria) than by sneezing (2.5 K bacteria). The Tuberculous Mycobacteria may survive even if the droplets dried up and may continue to float for days on air. It is recommended that the rooms the TB patients occupy should be airy to lessen their concentration and would be better that they are exposed to sunlight to kill the bacteria. Patients are likewise advised to wear masks. Perhaps in special cases, exhaust fans maybe needed.
Adult patients with lung cavitations are the ones who are infectious. Since pediatric patients seldom have cavitations and do not cough like adults, they do not spread the disease by droplets. Extra pulmonary lesions or TB lesions outside the lungs are non-infectious.
Dra. Lopez cautioned therefore the exposure of children to relatives with the disease. Likewise she recommended that hired helpers especially those taking care of children should routinely have a chest x-ray.
Most medical practitioners are contented by a reliable chest x-ray but definitive diagnosis in adults is thru a positive sputum smear. This test is easily done in most Municipal Health Centers. In pediatric patients, it is thru bronchial or gastric aspirations although these are rarely done. Diagnosis is usually thru clinical manifestations as mentioned above with positive PPD tests and significant chest x-rays. History of exposure and absence of BCG immunization which are supposed to be a must in children are also considered.
Healthy children with strong resistance or immunity who are infected with Primary Complex may easily recover even without medical treatment. Hence the disease is sometimes erroneously labeled as self limiting. Actually, the disease may be “latent” and resurgence may occur when the resistance or immunity later goes down. This may occur when other diseases infect the patient like HIV, pneumonia, chicken pox, measles, etc. Resurgence maybe pulmonary or unfortunately extra pulmonary like meningitis (brain), Pott’s Disease (spine) or tuberculosis of the intestine, kidney, etc.
Standard treatment is usually for 6 months. For the first 2 months, 3 drugs (triple therapy) are given. For the next 4 months, this is reduced to 2 drugs. The variations and dosages of the standard medicines are however computed strictly so that it is preferable that they are prescribed by experienced pediatricians. Follow up is likewise strictly advised because non-compliance may contribute to the appearance of resistant strains. The patient may appear to have recovered when actually it is not complete. The disease may then become “insidiously chronic” and may cause “disability” of the child eventually as he/she grows up. **
