Tuberculosis in children

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Abstract

Epidemiology of tuberculosis (TB) in childhood is closely related to TB in adults. Serious manifestations are often observed in children with TB. Immunological immaturity and social dependence facilitate the spread of infection.

Paediatricians account in practise both primary TB, with hilar lymphadenopathy, and subacute or chronic pulmonary complications, in TB disease. Children appear to have a higher risk of having extrapulmonary TB involving any organ.

The diagnosis of tuberculosis reactivation/re-infection, is based in the isolation of the agent in the sputum [7]. Primary TB is difficult to diagnose, usually established by indirect signs of low epidemiological specificity, symptoms, chest radiography and the intracutaneous tuberculin test. In this context, one can understand the importance of correct interpretation of the chest radiograph.

Chest CT is recommended if the chest radiograph is equivocal. In addition, an overview of extrapulmonary cases of TB – of the spine, bone and lymph nodes – including the role of other imaging modalities (Us and MR) will be presented [1], [3].

Section snippets

Introduction and pathogenesis

The pathologic form of pulmonary infection depends on the sensitivity of the infected host and is classified as primary or postprimary [4], [6].

Primary tuberculosis typically appears as air-space disease consolidation in the lower lobes, hilar and mediastinal lymphadenophty, pleural effusion and miliary disease.

Postprimary tuberculosis appears most commonly as nodular and linear areas of increased opacity or increased attenuation at the lung apex. Pleural effusion and miliary disease are less

Infection—the primary complex

The knowledge of how the installation of bacillus is established after the infecting contact is essential to the interpretation of radiological images. After the inhalation of one the infecting micro particle one more bacteria will flow through the respiratory tree and will set in one bronchiole or in one alveolus. There, the infecting bacillus will multiply and this proliferation unchains from the host a local inflammatory acute reaction, resulting in a parenquymatous nodule, called primary

Evolution and complications

In accordance with the virulence of the organism and the defenses of the host, tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients. These can be categorised as follows [5]:

  • 1.

    Parenchymal lesions: Tuberculoma, thin-walled cavity, cicatrization, lung destruction, aspergilloma and bronchogenic carcinoma.

  • 2.

    Airways lesions: Bronchiectasis,

Conclusion

Several of thoracic sequels and complication may result from TB and may involve the lungs, airways, vessels, mediastinum, pleura, chest wall, or any combination of these structures. Knowledge of the spectrum of radiological features of the sequels and complication of TB in pulmonary and extrapulmonary portions of the thorax is important to facilitate diagnosis.

References (7)

  • S. Andronikou et al.

    Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis

    Pediatr Radiol

    (2004)
  • A.N. Leung

    Pulmonary tuberculosis: the essentials

    Radiology

    (1999)
  • Cremin BJ, Jamieson DH. Imaging of pulmonary tuberculosis. In: Cremin BJ, Jamieson DH, editors. Childhood tuberculosis:...
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