Table 2.
Key clinical pearls in the diagnosis and management of DR-TB in children.
| Key clinical pearls |
| Consult with experts in paediatric TB on diagnosis and management, particularly for cases of DR-TB. |
| Clinical guidelines have been published regarding TB diagnosis and treatment [6,12,14]. |
| Diagnosis and evaluation |
| TB is a clinical diagnosis based on clinical findings, epidemiological context and likelihood of exposure, risk factors for progression to TB disease and laboratory/radiographical evaluations. Negative TB testing does not preclude a TB diagnosis. |
| A high index of suspicion is critical to diagnosis of paediatric TB and identification of DR-TB. |
| Children may present with pulmonary or extrapulmonary disease. TB in children can be challenging to diagnose and may carry a poor diagnosis if diagnosed late. |
| Infants must have CSF studies performed to evaluate for TB meningitis as part of their diagnostic evaluation. A low threshold to obtain CSF studies in young children is recommended. |
| Seek culture data from a likely source case whenever possible. |
| HIV testing should be done when evaluating for TB in any age group. |
| TB in children represents recent TB transmission. A careful history may reveal TB exposure, including to contact with chronic cough not yet diagnosed with TB. All family members and close contacts should be evaluated. |
| Management |
| Clinical guidelines review the current evidence base and guide the composition of a regimen for MDR-TB with drugs to which the specific TB isolate is probably susceptible [6]. |
| Treatment courses for MDR-TB are prolonged and can be as long as 2 years. Optimal treatment duration and all-oral treatment regimens are currently being studied. |
| Preventing TB |
| Children exposed to pulmonary TB should be carefully evaluated for TB disease and, in the absence of evidence of TB, should be commenced on TB preventive therapy (TPT). |
| Children exposed to pulmonary DR-TB found not to have TB disease should be commenced on TPT with activity against DR-TB.* They should be monitored at least monthly during treatment to assess adherence and for clinical signs of TB. |
*
For example, with levofloxacin. Refer to clinical guidelines [6] and current evidence in choosing a TPT regimen. Note: These are not comprehensive, and consultation should always be sought from an expert in paediatric TB and with reference to current clinical guidelines.