Tuberculosis

Tuberculosis (TB) is an ongoing (chronic) infection caused by bacteria. It usually infects the lungs. But other organs such as the kidneys, spine or brain may be affected. TB is most often spread through droplets breathed or coughed into the air. Your child can be infected with the TB bacteria and not have active TB disease.

The stages of TB are:

• Stage 1: Exposure. This occurs when a child has been in contact with a person who may have or does have TB. The child will have a negative skin test, a normal chest X-ray and no symptoms
• Stage 2: Latent TB infection. This occurs when a child has TB bacteria in his or her body, but does not have symptoms. The infected child’s immune system causes the TB bacteria to be inactive. For most people who are infected, the TB will be latent for life. This child would have a positive skin test but a normal chest X-ray. He or she can't spread the infection to others
• Stage 3: TB disease.This is when a child has signs and symptoms of an active infection. This child would have a positive skin test and a positive chest X-ray. He or she can spread the disease if untreated

TB is caused by bacteria. It’s most often caused by Mycobacterium tuberculosis (M. tuberculosis). Many children infected with M. tuberculosis never develop active TB and remain in the latent TB stage.

TB bacteria is spread through the air when an infected person coughs, sneezes, speaks, sings or laughs. A child usually does not become infected unless he or she has repeated contact with the bacteria. TB is not likely to be spread through personal items, such as clothing, bedding, cups, eating utensils, a toilet or other items that a person with TB has touched. Good air flow is the most important way to prevent the spread of TB.

TB can grow and cause an active disease in a child with a weak immune system. This can include children who:

• Have HIV
• Have diabetes
• Are being treated with medicine that can weaken the immune system, such as corticosteroids or chemotherapy

Very young children are more likely than older children to have TB spread through their bloodstream and cause complications, such as meningitis.

A child is more at risk for TB if he or she:

• Lives with someone who has TB
• Is homeless
• Comes from a country where TB is common
• Has a weak immune system

Symptoms can occur a bit differently in each child, and they depend on your child's age. The most common symptoms of active TB in younger children include:

• Fever
• Weight loss
• Poor growth
• Cough
• Swollen glands
• Chills

The most common symptoms of active TB in adolescents include:

• Cough that lasts longer than three weeks
• Pain in the chest
• Blood in sputum (mucus)
• Weakness
• Tiredness
• Swollen glands
• Weight loss
• Decrease in appetite
• Fever
• Sweating at night
• Chills

The symptoms of TB can be like other health conditions. Make sure your child sees his or her health care provider for a diagnosis.

Your health care provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history and will give your child a physical exam.

TB is diagnosed with a TB skin test. In this test, a small amount of testing material is injected into the top layer of the skin. If a certain size bump develops within two or three days, the test may be positive for TB infection. Your child may also need a chest X-ray and sputum test. A blood test called interferon-gamma release assays (IGRA) may also be done.

A TB skin test is advised for children who:

• May have been exposed to TB in the last five years
• Has an X-ray that looks like TB
• Has any symptoms of TB
• Comes from a country where TB is common

Yearly skin testing should be done on children who:

• Have HIV
• Are in a detention facility

A child who is exposed to high-risk people should be tested every two to three years.

A child may get TB skin testing from ages four to six and 11 to 16 if he or she:

• Has a parent from a high-risk country
• Has traveled to a high-risk area
• Lives in a densely populated area

Treatment may include a short-term hospital stay to be treated with medicine. For latent TB, your child is given a six to 12-month course of the medicine isoniazid. Or, your child may be prescribed a shorter course of another medicine. For active TB, a child may take three to four medicines for six months or more. This is to make sure that the medicine is working.

Children usually start to get better within a few weeks of starting treatment. After two weeks of treatment with medicine, a child is usually not contagious. Medication must be taken exactly as prescribed. It is important that your child take all of the medicines for the entire time period. Talk with your child’s health care provider about the risks, benefits and possible side effects of all medicines. Be sure to ask questions if you have them.

TB can be prevented by lowering your child’s risks for the disease. Risks include children living with someone who has TB, coming from a country where TB is common, having a weak immune system or children who are currently homeless.

Call your child’s health care provider if:

• Your child’s symptoms don’t get better, or get worse
• Your child presents new symptoms