Description
These comprehensive lecture notes on the Management of Childhood Tuberculosis, authored by Dr C Chabala from the University of Zambia's Department of Paediatrics & Child Health, provide critical guidance for tertiary-level medical and public health students. The material addresses the significant global and Zambian burden of childhood TB, outlining the diagnostic approach requiring a combination of contact history, symptoms, radiology, and bacteriology. It details the basic principles of TB treatment in children, including the standard six-month regimen with an intensive and continuation phase, using first-line drugs Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol. The notes extensively cover the management of TB-HIV co-infection, including ART timing, drug interactions, and overlapping toxicities. A significant portion is dedicated to Multi-Drug Resistant TB, defining its categories and explaining the indications, regimens, and challenges of treatment. The resource also covers TB prevention strategies such as BCG vaccination, contact screening, and Isoniazid Preventive Therapy. This is an essential resource for students in medical, nursing, and pharmacy degree programmes, equipping them with the knowledge needed for clinical management and exam preparation regarding this major paediatric health challenge. Use these detailed notes to enhance your understanding of contemporary childhood TB management protocols.
What's inside
Management of Childhood TB Dr C Chabala, MBChB, MMed, MSc University of Zambia, School of Medicine Department of Paediatrics & Child Health Epidemiology Global burden of Paediatric TB • 1 m cases of child TB annually; 10-11% of TB cases; > 15% high burden countries. • A quarter of children with TB die from it; • Child TB mortality rate 23% vs 16% in all TB cases • 17% TB deaths in HIV+ children • Majority undiagnosed and untreated due to poor access to diagnostic and preventive services • Estimated 25,000 children develop multi-drug resistant TB every year. WHO 2018 Dodd 2017 TB burden in children & adolescents TB mortality in children TB case detection gap in children WHO 2018 Global TB report Zambia TB Profile WHO 2018 Global TB report Zambia TB Profile TB burden in children TB prevention in children Diagnosis of child TB Diagnostic Approach for childhood TB? • DIAGNOSIS: Need at least 3/4 of the following elements 1. Infection 1. Contact history (clinical history) 2. Positive skin test (tuberculin skin test) 2. Symptoms of chronic disease (Clinical history) 1. Cough, Fever, Weight loss, night sweats, reduced playfulness) 3. Radiological changes suspicious of TB (Chest Xray) 4. Bacteriology (Smear microscopy, Gene-Xpert, MTB cultures, Urine LAM) Symptoms of chronic disease Cough, Fever, Weight loss, night sweats, reduced playfulness Risk of TB infection TB contact history Tuberculin skin test TB Bacteriology GeneXpert Smear microscopy Mycobacterial culture Urine LAM Abnormal CXR Radiological changes suspicious of TB Treatment of TB in children Basic principles of TB treatment in children • Same principles as adults • Cure the patient • Prevent relapse, death • Prevent development of drug resistance • Reduce transmission • Minimise toxicity • Prolonged treatment with multiple drugs; ‘short course’ • 6 months regimen • Intensive phase; 2 months • continuation phases ; 4 to 10 months • Supervised treatment • Directly observed therapy Considerations when initiating anti-TB treatment •Type of disease • Severe (TBM, Miliary, Spinal) vs non-severe forms (lung, Pleura, LN) •Regimens • In accordance with national TB programs •Dosages • According to weight of child • Use of fixed dose combination tablets (FDCs)
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