Table 5.
Evaluation for Active Tuberculosis Disease in Children With a Positive Test Result for Infection9,16
| Evaluation | Components |
|---|---|
| Historya | > 2 weeks of fever, cough, or lymphadenopathy Weight stasis or weight loss Decreased activity or playfulness Symptoms such as hemoptysis and night sweats are less sensitive in children than in adolescents and adults |
| Physical examinationa | Intrathoracic: reduced breath sounds, focal rales, increased work of breathing Lymphadenopathy: most commonly anterior cervical chain or supraclavicular, nontender, often > 2 × 2 cm in size Meningitis: mental status examination, focal cranial nerve deficits |
| Chest radiographa | Posterior-anterior and lateral radiographs should be obtained to evaluate for intrathoracic disease. The most common findings of TB disease in children are intrathoracic (hilar, mediastinal) lymphadenopathy, focal infiltrates, atelectasis, parenchymal calcifications, and pleural effusions; cavitary lesions are rare before adolescence. The thymic silhouette can mask lymphadenopathy on the frontal radiograph, making obtaining a lateral radiograph especially critical in young children |
| Microbiologic evaluation for children with suspected disease | Sputum or gastric aspirates for AFB stain and culture Sputum or gastric aspirates for Mycobacterium tuberculosis PCR, Xpert (Cepheid, Sunnyvale, CA) MTB/RIF, or other molecular tests for rapid identification of drug resistance Consider lumbar puncture for infants (< 12 months old) with suspected intrathoracic TB, infants and children with miliary TB, and children with altered mental status or focal cranial nerve findings |
AFB = acid-fast bacilli; MTP = Mycobacterium tuberculosis; TB = tuberculosis; PCR = polymerase chain reaction; RIF = rifampicin.
a
Should be performed for all children with a positive test of infection to adequately exclude TB disease.