These include: — Respiratory insufficiency due to extensive lesions and destroyed lungs; — Massive haemoptysis due to large cavities with hypervascularisation and erosion of vessels; — Pneumothorax due to the rupture of a cavity in the pleural space. In an endemic area, the diagnosis of PTB is to be considered, in practice, for all patients who have experienced respiratory symptoms for more than 2 weeks.
For differential diagnosis in HIV-infected patients, see Section 2. Table 2. Response to broad-spectrum antibiotics with no anti-TB activity suggests bacterial pneumonia.
Lobar consolidation is typical of bacterial pneumonia, however, X-ray alone cannot differentiate TB from bacterial pneumonia. Bad smelling, purulent sputum. Cavities typically have a thick-wall and air-fluid levels. Bronchectiasis Frequent complication of successive, poorly treated bronchopulmonary infections in tropical regions.
Haemoptysis, usually mild, can be present. In this study, it is important to note the tendency of greater number of positive cultures in patients with history of BCG immunization, where we supposed to have a lesser mycobacterial replication and in consequence a lesser number of bacilli. In our series, all the patients were symptomatic when the diagnosis was made, similar to that described by Vallejo et al.
We found nonspecific signs and symptoms with fever and cough being the most consistent clinical manifestations, independently of age, which account for Nonetheless, loss of weight was seen in most of the patients independently of the age.
Expectoration and hemoptysis were significantly more frequent in the group older than 14 years, which is similar to the findings in adults with PTB [ 20 ]. PPD was positive in an important proportion of the cases Radiological studies play an important role in the diagnosis of tuberculosis in pediatric age. Although there can be some differences in its interpretation, the findings suggestive of PTB in children under 5 years old are of great support for its diagnosis.
In this series, the image of consolidation was a frequent finding in all age groups and was significantly more frequent in patients older than 5 years, in contrast with mediastinal lymphadenopathies, which were present in children below this age coinciding with what was reported by other authors. The miliary pattern was seen in only 6. Pleural effusion is infrequent in pediatric age but in our series it was seen in The presence of calcifications and caverns were significantly more frequent in patients above 14 years old due to the fact that it is an infrequent complication of primary tuberculosis [ 10 , 12 , 16 , 21 — 23 ].
Based on this, it was suggested that children fulfilling 2 of these 3 criteria should be evaluated with chest X-ray and ZN positive [ 24 , 25 ]. In this study however, ZN was positive in With respect to this, it is important to note that this was performed in children older than 5 years old in whom PTB forms such as caverns contain a greater number of mycobacteria in contrast with the type of lesions found in children less than this age where the TB is habitually paucibacillary.
Mycobacterium identified by culture is present in PCR value in diagnosis of tuberculosis in pediatrics is still controversial due to the false positives, mainly in countries with high endemicity for tuberculosis, and to the false negatives that are reported. In this study it was positive in Antituberculous treatment was well tolerated in most cases. Patients responded well to the treatment even when there was one death, precisely a boy with HIV and multidrug resistant tuberculosis without adherence to treatment.
The other 2 deaths were not attributable to tuberculosis. Diagnosis of PTB in pediatric population represents a challenge due to nonspecific nature of its signs and symptoms and to the low possibility of identification of Mycobacterium tuberculosis , as we found in this series of cases only in So, clinical suspicion, chest X-ray findings, and contact study with the aim of establishing a timely treatment are fundamental in its diagnosis. It is important to say that monitoring the clinical evolution is fundamental in all cases, given that in an important number of them, treatment is indicated without microbiological correlation.
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An Esp Pediatr. PubMed Google Scholar. Meta-analysis of the published literature. Indian Pediatr. Starke JR: Diagnosis of tuberculosis in children. Starke JR: Childhood tuberculosis: A diagnostic dilemma. J Pediatr. Tuber Lung Dis. Download references. We thank Dr Cyril Ndidi Nwoye a native English speaker for translating the manuscript, and reviewing and giving it the needed standard style.
You can also search for this author in PubMed Google Scholar. All authors read and approved the final manuscript. Reprints and Permissions.
Pulmonary Tuberculous: Symptoms, diagnosis and treatment. BMC Infect Dis 14, Download citation. It does not mean that you have active TB or are contagious. Talk to your provider about how to prevent getting TB. Prompt treatment is very important in preventing the spread of TB from those who have active TB to those who have never been infected with TB. But, the effectiveness of this vaccine is limited and it is not used in the United States for the prevention of TB.
Discuss the test results if positive with your provider. Mycobacterium tuberculosis. Philadelphia, PA: Elsevier; chap Hauk L. Am Fam Physician. PMID: pubmed. Wallace WAH. Respiratory tract. In: Cross SS, ed. Underwood's Pathology. Updated by: Jatin M. Editorial team. Pulmonary tuberculosis. When symptoms of pulmonary TB occur, they can include: Breathing difficulty Chest pain Cough usually with mucus Coughing up blood Excessive sweating, particularly at night Fatigue Fever Weight loss Wheezing.
Exams and Tests. The health care provider will perform a physical exam. This may show: Clubbing of the fingers or toes in people with advanced disease Swollen or tender lymph nodes in the neck or other areas Fluid around a lung pleural effusion Unusual breath sounds crackles Tests that may be ordered include: Bronchoscopy test that uses a scope to view the airways Chest CT scan Chest x-ray Interferon-gamma release blood test, such as the QFT-Gold test to test for TB infection active or infection in the past Sputum examination and cultures Thoracentesis procedure to remove fluid from the space between the lining of the outside of the lungs and the wall of the chest Tuberculin skin test also called a PPD test Biopsy of the affected tissue done rarely.
Outlook Prognosis. Possible Complications.
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