PE31.1 | Childhood Tuberculosis Clinical Spectrum — Summary & Reflection

KEY TAKEAWAYS

Childhood tuberculosis is a spectrum from latent TB infection (positive TST, no active disease) through primary complex (Ghon focus + hilar lymphadenopathy) to progressive forms — miliary TB (haematogenous bilateral millet-seed nodules), TBM (insidious meningitis staged I/II/III by MRC), and EPTB (lymphadenitis, abdominal, Pott's disease, pericardial). The primary complex is the defining paediatric lesion; lymphadenopathy dominates and can cause airway compression. Children <5 years, those with malnutrition (SAM: MUAC <11.5 cm or WFH <−3 SD), and HIV-infected children face the greatest risk of rapid dissemination. BCG vaccination at birth (NIS) protects against the severe disseminated forms. Contact with a smear-positive adult is the highest-risk exposure. All suspected TB cases in children must be evaluated with contact history, nutritional status, BCG scar, Mantoux/TST, CXR, and microbiological sampling — the diagnostic skills covered in the companion SDL.

REFLECT

Think back to the 3-year-old boy in the opening scenario whose father had TB 4 months ago. Having worked through this module, reconstruct his clinical situation: (1) What type of primary TB does his CXR represent? (2) If the hilar lymph nodes were to enlarge further, what complications would you anticipate? (3) The mother asks: 'Will my son be infectious to his siblings at school?' — how would you counsel her, based on what you know about paucibacillary childhood TB? (4) How does his malnutrition modify his prognosis, and what can be done about it simultaneously with TB treatment? Reflect on how this single child's case unifies the entire clinical spectrum you have just studied.