Pulmonary Tuberculosis (TB) in Children
Pulmonary Tuberculosis (TB)
A15.0-3/A15.7-8/A16.0-2/A16.4/A16.7-8 + B20.0
Most children acquire tuberculosis from infected adults by inhalation. Malnourished, immunosuppressed (HIV and AIDS) children, and children < 5 years of age, are at increased risk for pulmonary tuberculosis.
DIAGNOSIS
Any child presenting with symptoms and signs suggestive of pulmonary TB is regarded as a case of TB if there is:
- A chest X-ray suggestive of TB,
AND/OR
- History of exposure to an infectious TB case and/or positive tuberculin skin test (TST) e.g. Mantoux.
A positive TB-NAAT and/or smear microscopy and/or culture, on early morning gastric aspirate or induced sputum, confirms TB disease.
Signs and symptoms include:
- Unexplained weight loss or failure to thrive
- Unexplained fever for ≥2 weeks
- Chronic unremitting cough for >14 days
- Lymphadenopathy (especially cervical, often matted)
- Hepatosplenomegaly
- Consolidation and pleural effusion
Tuberculin skin test (TST), e.g. Mantoux:
- A positive test: TST induration ≥10 mm
- A TST may be falsely negative in the presence of:
- Malnutrition
- Immunodeficiency, e.g. HIV and AIDS
- Immunosuppression, e.g. steroid therapy, cancer chemotherapy
- Following overwhelming viral infection, e.g. measles or post vaccination
- In these circumstances a TST induration ≥5 mm may be regarded as positive. Frequently, the TST will be non-reactive in these cases. TB treatment should be considered, despite a negative TST
The following may be evident on chest X-ray:
- Direct or indirect evidence of hilar or mediastinal adenopathy with or without parenchymal opacification and/or bronchopneumonia
GENERAL MEASURES
- Identify and treat the source case
- Screen all contacts for TB infection
- Monitor the nutritional status of the child to assess response to treatment
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4-Version 1.0_16 September 2024
Chapter 17: Respiratory Conditions_17.4 Pulmonary Tuberculosis (TB)_17.4.2 Pulmonary Tuberculosis (TB) in Children
ICD-10 codes
- A15.0Tuberculosis of lung, confirmed by sputum microscopy with or without culture
- A15.1Tuberculosis of lung, confirmed by culture only
- A15.2Tuberculosis of lung, confirmed histologically
- A15.3Tuberculosis of lung, confirmed by unspecified means
- A15.7Primary respiratory tuberculosis, confirmed bacteriologically and histologically
- A15.8Other respiratory tuberculosis, confirmed bacteriologically and histologically
- A16.0Tuberculosis of lung, bacteriologically and histologically negative
- A16.1Tuberculosis of lung, bacteriological and histological examination not done
- A16.2Tuberculosis of lung, without mention of bacteriological or histological confirmation
- A16.4Tuberculosis of larynx, trachea and bronchus, without mention of bacteriological or histological confirmation
- A16.7Primary respiratory tuberculosis without mention of bacteriological or histological confirmation
- A16.8Other respiratory tuberculosis, without mention of bacteriological or histological confirmation
- B20.0HIV disease resulting in mycobacterial infection