What is Extrapulmonary Tuberculosis?
Extrapulmonary tuberculosis (EPTB) is a form of tuberculosis (TB) that occurs outside the lungs. In pediatric patients, EPTB can affect various organs and systems, including lymph nodes, abdomen, bones and joints, and the central nervous system. Unlike pulmonary TB, which predominantly involves the lungs, EPTB presents a diagnostic challenge due to its varied and sometimes subtle symptoms.
How Common is Extrapulmonary Tuberculosis in Children?
EPTB is relatively less common compared to pulmonary TB, but it still represents a significant proportion of TB cases in children, particularly in regions with high TB prevalence. Children are more susceptible to severe forms of TB due to their immature immune systems.
What are the Risk Factors for EPTB in Pediatric Patients?
Several risk factors predispose children to develop EPTB. These include
malnutrition,
HIV infection,
immunosuppressive therapy, and living in close contact with individuals who have active TB. Additionally, younger children, especially those under the age of 5, are at a higher risk due to their underdeveloped immune systems.
- Tuberculous Lymphadenitis: Involvement of the lymph nodes, particularly in the neck area.
- Miliary TB: Disseminated form that spreads through the bloodstream, affecting multiple organs.
- Tuberculous Meningitis: Infection of the meninges, the protective membranes covering the brain and spinal cord.
- Skeletal TB: Involvement of bones and joints, commonly the spine (Pott's disease).
- Abdominal TB: Involvement of the gastrointestinal tract, peritoneum, or abdominal lymph nodes.
- Fever
- Weight loss
- Fatigue
- Night sweats
- Swelling of lymph nodes
- Persistent cough (in case of associated pulmonary involvement)
- Abdominal pain (in abdominal TB)
- Neurological symptoms (in tuberculous meningitis, such as headache, vomiting, and altered mental status)
- Clinical Evaluation: Thorough history and physical examination.
- Tuberculin Skin Test (TST) or Interferon-Gamma Release Assays (IGRAs): To detect TB infection.
- Imaging Studies: Chest X-ray, ultrasound, CT scan, or MRI depending on the suspected site of infection.
- Microbiological Tests: Sputum culture, gastric lavage, or biopsy of affected tissues for acid-fast bacilli (AFB) and molecular tests like PCR.
- Histopathological Examination: Biopsy of affected tissues to identify granulomas and other characteristic features.
What is the Treatment for EPTB in Children?
The treatment of EPTB in children involves a prolonged course of anti-tuberculous therapy (ATT), usually consisting of multiple drugs to prevent the development of drug resistance. The standard regimen includes:
- Intensive Phase: Generally 2 months of isoniazid, rifampin, pyrazinamide, and ethambutol.
- Continuation Phase: Followed by 4-7 months of isoniazid and rifampin.
The duration of treatment may vary based on the form and severity of EPTB. Corticosteroids may be used as adjunctive therapy in certain forms, such as tuberculous meningitis and pericarditis, to reduce inflammation and complications.
- Neurological Sequelae: From tuberculous meningitis, such as cognitive impairments and motor deficits.
- Skeletal Deformities: From skeletal TB, such as spinal deformities.
- Chronic Abdominal Issues: From abdominal TB, including intestinal obstruction.
- Dissemination: Leading to widespread organ involvement and severe illness.
- BCG Vaccination: Given at birth in TB-endemic countries to provide protection against severe forms of TB.
- Prompt Identification and Treatment: Of active TB cases to prevent spread.
- Screening and Prophylactic Treatment: For children in close contact with TB patients, particularly those with immunocompromising conditions.
In conclusion, extrapulmonary tuberculosis in pediatric patients presents unique challenges in diagnosis and management due to its varied manifestations and non-specific symptoms. Early recognition, comprehensive evaluation, and appropriate treatment are crucial to prevent severe complications and ensure favorable outcomes.
