Pediatric TB

Nearly 8-20% of deaths caused by  Tuberculosis (TB) occur in children.  Out of all the incident cases (majority of the cases occurring in high TB burdened countries) it is estimated to be 9.6% to 11%. Children can be affected at any age but the most common age is between 1 - 4 years. There is a high risk of developing TB in HIV infected children. It is noticed that tuberculosis and malnutrition often go hand in hand. Usually a child gets infected by an adult with active TB. The common symptoms are cough, fever, night sweats and lose of weight. Diagnosing TB in children can be difficult as children under the age of 10 usually cannot cough up enough sputum to be sent to the lab to confirm the infection of TB.  Even chest X-rays are difficult to interpret as the typical shadow is rarely seen. Hence the diagnosis is largely based on the above mentioned symptoms. Coming in close contact with an infectious patient or a positive Tuberculin skin test (TST) is also taken as a confirmation for TB.

Unfortunately very little importance is given to childhood TB resulting in severe consequences. Relatively few studies have been undertaken and children tend to be given the same mg/kg body-weight dosages of antituberculosis drugs as adults. This approach can be called as “one size fits all”. Prevention of childhood tuberculosis can be achieved by the use of the BCG vaccines.

All children who have been diagnosed with TB disease must receive directly observed TB treatment, short-course with the appropriate regimen and must be notified. Once the treatment for TB is started it should be continued until completion.

Nevertheless TB remains an important cause of childhood illness and death. There is a high risk of this disease progressing in young children and are much more likely to develop severe Tuberculosis. There is a real need for prospective epidemiological studies to determine the true burden of TB among children. Without the complete data on the true burden of disease to inform public health policy, childhood TB will remain an essentially invisible and neglected disease. 

More http://www.who.int/tb/challenges/children/en/

http://blogs.ngm.com/blog_central/2009/11/tbs-deadly-life.html

TB and India

Tuberculosis (TB) continues to be one of the world’s greatest challenges in the public health threat.The WHO has predicted that a failure to stop this epidemic will lead to about one billion people being newly infected, 125 million people developing TB and at least 30 million deaths from the disease by 2020.

India is the highest TB burden accounting more than 20% of the global incidence (global annual incidences 9.4 million, India annual incidence, 1.96 million -WHO 2009). This is twice as many cases as China which has the next highest number.

Childhood Tuberculosis: not gone

Tuberculosis (TB) in children is often a neglected, in terms of prevention, diagnosis, treatment, and monitoring prevalence. Children's, who are malnourished, orphans, or living with HIV vulnerable to this neglected epidemic. Many people consider TB a disease of the past, but TB remains a top killer of children worldwide, particularly because of their weaker immune systems. The WHO reported in 2009 that every year more than 1 million children get infected and about 176,000 die as a result. It’s time more action is taken to address this issue globally.

We (with VIDT) identified two child TB patients by our unique school level TB advocacy program and sputum collection campaign. TB care foundation provides free-of-charge medical care to the child TB patients as well as free nutritional supplements, food supplies, to the poorer Child TB patients.

Totally drug resistant TB

One of the biggest problems in Tuberculosis (TB) therapy nowadays is that patients have to take antibiotics for up to 9 months. As many patients feel better before this time, they prematurely stop their treatment, leaving pools of the most drug-resistant M. tuberculosis in their lungs. This contributes to the emergence of complete drug resistance in future patients.

In the past few years, strains of drug resistant Mtb have become prevalent. In fact, resistance is so wide spread that it is now being classified as multi-drug resistant (MDR-TB) and extreme-drug resistant (XDR-TB). Two of the world’s most populous countries, India and China, account for more than 50% of the world’s MDR-TB cases.

Recent reports have also confirmed a new strain of existing Mtb which is completely untreatable and has been designated as Totally drug resistance TB (TDR-TB). Indeed, strains of Mtb have even evolved resistance to all major available anti-TB drugs. India (2012) is the third country in which a total drug-resistant form of the TB has emerged, following cases documented in Italy in 2007 and Iran in 2009. There is a need for a more readily available treatment that are effective against both sensitive and drug-resistant strains of M. tuberculosis is evident.

Sign and symptoms of TB

Cough for three weeks or more
Fever, especially rising in the evening and night sweats
Pain in the chest
Tiredness or weakness
Loss of appetite and weight
Coughing up of blood

Who are vulnerable to TB

Family and close contacts of the patients
The elderly
People with low income
People with poor access to health care
People who inject illicit drugs
People who work in nursing homes/prisons/shelters for homeless or drug treatment center.