1. People’s Friendship University of Russia
Characteristics of tuberculosis
in childhood
Ghodiwala Tossif
Ml-610
Moscow 2013

2. • In early childhood tuberculosis has the
greatest tendency to progression, and that
leads to the development of the most severe
forms of tuberculosis.
• Child deaths from tuberculosis predominantly
observed at this age, most often in the first
year of life.
• The epidemiological situation of tuberculosis
in young children characterized by low
infectivity relatively high morbidity and high
mortality rate.

3. • Infant – generalized form of TB
• Preschool and school age – less generalized
and more particular to lymphatic system
• Adolescence- infiltrative and disseminated
form

4. Anatomical and physiological
characteristics INFANTS
• Immature immunity
• Slow immune response
• URT -short and wide unlike. LRT -longer and
narrow
• Relatively dry mucousa (insufficient number of
mucous glands)
• Poor elasticity of acini
• Insufficient surfactant
• Not well developed pleura
• Cough reflex not fully developed

5. Anatomical and physiological
characteristics Adolescent period
• Metabolic changes
• Neuro-endocrine imbalance
• Increase in the functional needs of the
organism
• Psychological changes
– Bad habits
– Diet
– Social status

6. Tuberculosis in different age categories has
certain features, which consequently
contributes to the formation of various degrees
of residual changes after the disease.

7. TB by the Numbers
• One-third of the world’s population has TB.
• 9 million people are infected each year.
• Roughly 1.5 million people die each year from
the complications of TB.
• 8.5 million children have been orphaned due to
TB.
• 22 countries account for 80% of TB cases
worldwide.

8. Incidence

9. Percent of US Pediatric TB Cases by Age Group
1993–2006
N=15,946
Age 10-14
18.2%
Age 5-9
23.1%
Age < 1
9.2%
Age 1-4
49.5%
CDC data

11. Distribution

12. High-risk Factors for
Childhood TB
• Poverty- Poor children often live in
overcrowded conditions and lack access to
healthcare.
• Young Age-Because of their weak immune
systems, infants under one year of age have a
40 percent chance of contracting TB if they do
not receive preventive therapy when exposed to
an adult with infectious TB.

13. • Malnutrition - Weak immune systems and
malnutrition go hand in hand and make
children more susceptible to active TB.
• HIV- TB is the third leading killer of children
with AIDS and kids with HIV are up to 20 times
more likely to develop TB than healthy
children.
• Maternal TB - Children often contract TB
from their mothers or other primary
caregivers who have TB.

14. Transitions in Childhood Tuberculosis
Contact with smear positive index case
Not infected (50-70%)
Infected (30-50%)
Diseased (10-30%)
Within 2 years (50%)
Lifelong (50%)

15. •
Risk of progression to disease is increased when
primary infection occurs particularly in the very young
(0–4 years).
•
Children who develop disease usually do so within 2
years following exposure and infection, i.e. they
develop primary TB.
•
A small proportion of children (generally older children)
develop post-primary TB either due to:
–
–
Reactivation, after a latent period, of dormant bacilli acquired
from a primary infection or
By reinfection.

16. Age at primary infection
Risk of disease following primary infection.
< 1year
No disease
Pulmonary disease (segmental)
TBM or miliary
50%
20-40%
10-20%
1-2 years
No disease
Pulmonary disease (segmental)
TBM or miliary
70%
10-20%
5-10%
2-5 years
No disease
Pulmonary disease (segmental)
TBM or miliary
95%
5%
0. 5%
5-10 years
No disease
Pulmonary disease (segmental, effusion or adult type)
TBM or miliary
98%
2%
<0. 5%
> 10 years
No disease
Pulmonary disease (adult type)
TBM or miliary
80%
10-20%
<0. 5%

18. “These kids are the reservoir for
adult TB,”
Dr. David Manissero

19. Which factors influence children to become
infected?
Mostly “Environmental”
• Exposure
- Never exposed = never infected
- Duration of exposure
• Bacterial load
• Close contact with infected

20. Only Adults Transmit TB
Adult
Number of bacilli in sputum
Child
108
104
Need about 105 organisms/ml for positive smear

21. What are the chances of a child under the age of
12 being able to transmit TB?
•Only a fraction of 1%

22. But why?
• Paucibacillary disease (fewer organisms)
• Cannot cough/spread infection as well

23. • In adults, the most common way to diagnose
TB is to look at mucus coughed up (sputum)
and test it for the TB germ through sputum
cultures.
• Most children, however, have a dry cough and
do not produce sputum. In the rare instance
that the child does produce sputum.

24. Difficult to diagnose
• paucibacillary, rarely culture confirmed :
• Sputum smear positive in 10.3% (10-14yr),
1.8% (5-9) and1.6% (<5)
• Cultures positive 21% (10-14), 5% (5-9) and
4.2% (<5),
• Extrapulmonary TB

25. Severity
• TB in children is more severe than adults.
• Infants have a particularly high morbidity and
mortality from TB.
• It is likely that the high rate of progressive TB
seen in young children is largely a reflection
on the immaturity of the immune response.

26. Every day, more than 200
children under the age of 15 die
needlessly from TB – a disease
that is preventable and curable.