Childhoold TB, a malaise that remains well-masked

Mahesh Hiranandani | Updated on March 15, 2019

India is unable to monitor the treatment compliance of adult TB patients

One in four children who die of tuberculosis is from India and of all children dying of TB in India, 96 per cent remain undetected and untreated.

Tuberculosis has long been a major public health concern in spite of advances in diagnosis and treatment.

A child gets TB pretty much the same way an adult does, by inhaling TB bacteria in the air that had been exhaled by someone with active TB.

It is rare that a newborn will get affected from an infected mother through placenta. But given the chronic nature of the disease, it needs prolonged therapy. Children in the age group younger than two and over 13 are most likely to contract TB. And most of them get pulmonary TB, confined to the lungs. But in a small number of them, TB spreads through the body and affects other organs. This is called disseminated or progressive TB.

Children are also at a greater risk than adults for tuberculosis meningitis, which is extremely dangerous and impairs the central nervous system.

Don’t ignore the symptoms

TB symptoms in children include persistent fever and cough, usually for more than two weeks, loss of weight, lymph node swellings despite appropriate treatment with antibiotics. A child could get seizures when the brain gets affected. So it’s important for parents to be aware of symptoms associated with childhood TB as it can also spread through parents if they are infected.

As with adults, initial screening for TB includes the tuberculin skin test, a chest X-ray and blood tests. Diagnostic tests include direct visualisation of the bacteria through a microscope by special stains from sources like sputum, gastric fluid from young children who cannot bring out their sputum, infected fluid from lungs, fluid from spinal tap or other affected sites.

TB culture from the above sources and DNA-based assay (CBNAAT-Cartridge based Nucleic Acid Amplification Test) are used for confirmation and to detect drug resistance. Again, the trouble when it comes to children is that diagnosis is difficult because their TB load is low. Getting the right treatment quickly to an infected child is especially important to prevent the disease from spreading and causing serious complications like TB meningitis.

Treatment depends on whether the child has asymptomatic TB infection or active TB disease — both require treatment.

The government does provide free treatment through its DOTS centres. But the important part is to complete the course of anti TB medicines as advised, to restrict the spread of multi-drug resistant (MDR) TB.

The duration of treatment varies from six to nine months depending upon the drug sensitivity and severity of the disease. And this results in early dropouts, allowing the remaining bacteria to grow uncontrollably to produce MDR Tuberculosis. Children often are the victims of poor management of adult TB patients who pass on these bugs to them.

It is indeed a global shame that India is unable to monitor the treatment compliance of adult TB patients.

But TB is preventable if diagnosed early and treated on time. For this, it’s important to eliminate the stigma around it. In addition to this, we need to promote good hygiene and health to boost immunity in the community and specifically for children, we need to encourage drug companies to bring out more child-friendly medicines.

The writer is Head of Pediatrics at Cloudnine Group of Hospitals, Chandigarh

Published on March 15, 2019

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