Overview

What is tuberculosis (TB)?

Tuberculosis (TB) is an airborne infection that affects the lungs and other parts of the body. TB is caused by the bacterium Mycobacterium tuberculosis.

There are two types of TB:

Latent TB infection: Patients who have latent TB infection have TB bacteria in their bodies, but the bacteria are not active and cannot be spread to others. These patients do not have symptoms of TB, but still take medicine to keep from getting TB disease.
TB disease: Patients who have TB disease have active bacteria, have symptoms of TB, and can pass the disease to others. These patients have to take medicine to treat the disease.

Latent TB infection is less serious than TB disease. If TB disease is not treated, it can lead to serious disability and/or death.

Which children are at greater risk for tuberculosis (TB)?

Children who are at greater risk for TB include those who:

Live in a house with an adult who has active TB.
Have a condition that weakens the immune system, such as HIV.
Live in a shelter.
Live with someone who has been to jail or is homeless.
Were born in a country with a high rate of TB.
Have been to a country where TB is regularly found.
Live in areas that cannot provide proper healthcare.

Statistics for TB in children

In 2011, 577 children 14 years old and younger in the United States had TB, a case rate of 0.9 per 100,000 (American Lung Association).

The World Health Organization states that about 500,000 children fell ill with TB, and 64,000 died from TB in 2011. Hispanic and non-Hispanic black children 14 years old or younger accounted for more than 7 out of 10 (71%) of TB cases in that group. Worldwide, it is estimated that there are at least 1 million cases of TB among children less than 15 years of age each year.

Symptoms and Causes

How is tuberculosis (TB) spread to children?

Most children (if not all) get TB disease from an adult who has active TB disease. The TB bacterium spreads through the air when a person infected with TB coughs, sneezes, or speaks. If a child is in the area, he or she may be exposed to the bacteria.

Children are less likely than adults to spread TB bacteria to others because the forms of TB disease found in children are less infectious. Children younger than 10 years old are less infectious because they tend to have an ineffective cough and have very few bacteria in their mucus secretions. Infants, young children, and immunocompromised children (those with a weakened immune system) are at the highest risk of developing the most severe forms of TB, such as TB meningitis or disseminated TB disease.

What are the symptoms of tuberculosis (TB) disease?

The symptoms of TB disease include the following:

Cough
Difficult (heavy, fast) breathing
Swollen glands
Weakness and feeling less playful
Weight loss and/or poor growth
Fever and/or night sweats
Irritability and/or lethargy (feeling tired)

Children may have TB disease without symptoms. When the bacteria reach the lungs, the body’s immune system attacks the bacteria and keeps the infection from spreading.

Diagnosis and Tests

How is tuberculosis (TB) diagnosed?

Children who are at risk for contracting TB should receive a TB test. There are two TB tests for TB infection: a skin test or a blood test.

During a tuberculin skin test, a small needle is used to place tuberculin (testing material) under the skin on the forearm. In two to three days, the patient returns to the healthcare provider, who will check the reaction to the test. If there has been an infection, the patient’s skin will swell and redden at the injection site.
A TB blood test measures how a person’s immune system reacts to the bacteria that cause TB.

To test for TB disease, other tests such as a chest X-ray and a sample of sputum (mucus that is coughed up from the lower airways) may be needed. Diagnosis of tuberculosis in children is difficult, because children are less likely to have symptoms of tuberculosis. Also, sputum samples are difficult to collect from children.

Management and Treatment

How is tuberculosis (TB) in children treated?

If a child is thought to have TB, he or she should be treated by a pediatric TB expert. It is very important that children being treated for latent TB infection or TB disease finish the medicine and take the drugs as instructed.

Latent TB infection treatment: Latent TB infection in children must be treated in order to prevent the development of TB disease. Isoniazid (Hyzyd®) is a drug that keeps the infection from becoming active. Isoniazid is taken by mouth once a day every day for at least 9 months.
TB disease treatment: Treatment for TB disease requires 3 to 4 drugs. The patient will take these drugs for 6 to 12 months. The patient may initially be hospitalized for treatment. It is important to take the drugs until completed, or the patient can get sick again.

TB that is resistant to drugs is harder to treat. Those treatments can last 18 to 24 months.

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Tuberculosis (TB) in Children