Tuberculosis in children: signs, risks, and how to protect them

Tuberculosis is quite a serious illness. There are at least 10 million new cases each year, with over 1.25 million deaths globally. Tuberculosis is one illness that is curable, preventable, and yet remains a global health crisis.

While most are aware of tuberculosis, few understand the exact workings of this disease on a cellular level. What causes TB? How does it spread? Who is the most vulnerable demographic?

All of these questions are answered through the correct information provided by healthcare providers. Understanding the disease is the first step to prevention and early intervention. In this blog, we will explore how tuberculosis presents in children, the symptoms, risks, and how you can protect them.

What is Tuberculosis?

Tuberculosis, or TB, is a serious condition that affects the lungs primarily. Tuberculosis is caused by the Mycobacterium tuberculosis bacteria. Although the lungs are most commonly affected, TB can reach other parts of your body. It spreads through the air, so it is highly contagious. An infected person sneezing or coughing can release droplets into the air that can be inhaled by anyone.

TB is commonly found in crowded regions; the overpopulation creates a breeding ground for TB bacteria. People with autoimmune diseases or other health conditions that weaken their immune systems are more vulnerable to contracting TB.

Typically, TB is treated with antibiotics. Some variants of the classic TB strain may be resistant to antibiotics, making treatment more complicated.

What is the difference between TB infection and TB disease?

TB infection refers to the situation where the TB bacteria are present in your body, but there is no active infection. The patient’s immune system is fighting to keep the bacteria inactive and under control. Despite carrying the bacteria, the patient may not exhibit symptoms. They are also not contagious while the bacteria remain inactive.

TB disease, on the other hand, is an active infection stage. The patient will experience all the symptoms and be highly contagious. TB disease can also spread through the body and become fatal if left untreated.

Signs and symptoms of TB disease in Children

The signs and symptoms of TB in children are similar to adults.

Tuberculosis symptoms vary according to the infection stage. Initially, the bacteria enter your lungs and begin multiplying. This is called an active TB infection. In the first stage, i.e., Primary TB Infection stage, the patient’s immune system is fighting hard to protect the body from infection. This is the case if the patient is otherwise healthy. While some germs may die, many may survive and multiply. Symptoms are subtle in the first stage. The patient may feel tired, experience coughing, and have a low fever.

Then comes the Latent TB Infection stage. In this stage, the patient’s immune system continues fighting. Active infection has still not begun. The immune system protects the lung walls to prevent further harm. There are no symptoms during this stage.

The final stage is the Active TB Disease stage. During this stage, an active infection has begun. The bacteria have begun to spread through the lungs, affecting the patient’s health. The bacteria may even spread to other parts of the body at this stage. Active TB Disease can happen right after primary infection or even months and years later. Symptoms of this stage include:

• Coughing
• Sneezing
• Chest pain
• Coughing up blood or mucus
• Shortness of breath
• Fever
• Chills
• Night sweats
• Unexplained weight loss
• Loss of appetite
• Fatigue
• Overall compromised health

If the TB spreads to other parts of the body, it is called extrapulmonary tuberculosis. TB can spread to the following organs:

• Kidneys
• Liver
• Genitals
• Lymph nodes
• Bones & joints
• Skin
• Heart
• Fluid around the brain and spinal cord
• Blood vessels
• Larynx (voice box)

In children, there may be a fever that does not go away and unexplained weight loss. In infants, growth is impacted. The baby may not grow or gain weight as expected. Babies are more likely to experience swelling in the fluid that protects the brain and spinal cord. Infants may:

• Feed poorly
• Become sluggish
• Become fussy, even more so than usual
• Experience vomiting
• Have poor reflexes
• Experience a bulge on the soft spot on their head

Risk Factors for Childhood TB

There are several factors that can increase the risk of TB in children. Let’s take a look at some risk factors for childhood TB:

• Exposure:

Exposure to an infected person, most commonly an adult, is one of the primary risk factors for childhood TB. This is the case especially in crowded homes or confined spaces.

• Weak Immune Systems:

Children who have had prior illnesses, autoimmune diseases, or a generally weak immune system are at a higher risk of contracting TB. Conditions like HIV, malnutrition, diabetes, etc., can weaken a child’s developing immune system. 

• No Vaccine

Children are at a high risk of contracting TB and quick progression of the disease. If they are not vaccinated with the BCG vaccine, they are more vulnerable than their vaccinated peers. While the BCG vaccine is not a foolproof solution, it can significantly lower one’s risk of developing TB.

• Crowded spaces

TB is known to be most prevalent in crowded spaces. Spaces without proper ventilation can increase the risk of contracting TB substantially, especially among children.

• Age

The younger the age, the higher the chances of contracting TB. Children younger than five years old are the most susceptible to TB disease. Their developing immune systems make them prone to developing various illnesses, including TB disease.

How TB is Diagnosed in Children

Diagnosis begins with learning about the symptoms. If there is an active infection, symptoms like persistent cough, fever, fatigue, weight loss, or night sweats are present. Your Doctor will check for risk factors like exposure to an infected person or living in an area where TB is prevalent.

Following this, the doctor conducts physical screening. A physical examination can reveal symptoms like enlarged lymph nodes or a distended abdomen with ascites. Since TB primarily affects the lungs, a chest X-ray will be conducted. A chest X-ray can provide a clearer image of the extent of the spread of TB.

Bacterial tests reveal the presence of Mycobacterium tuberculosis. Obtaining samples from young children can be difficult since they possess an inability to produce sputum on demand.

Biopsy and culture tests can help diagnose cases of extrapulmonary tuberculosis. In extrapulmonary TB, the disease spreads to other organs in the body. A biopsy of a tissue sample can help identify the culture and identification of TB bacteria. 

How to Protect Children from TB

There are vaccines available to protect your children and yourself from Tuberculosis. The Bacille Calmette-Guerin (BCG) vaccine is the most commonly used vaccine against TB. In countries where TB is common, infants and small children receive the vaccine as early as possible. Children are more susceptible to getting severe forms of TB and other TB complications like TB meningitis.

Children often contract tuberculosis from adults who are infected. Treating the adults is a good way to protect the children from TB.

Tuberculosis preventive therapy (TPT) can prevent latent TB infection from turning into active TB disease. TPT can reduce the risk of active infection by almost 60%.

If your child has been in contact with someone experiencing active TB disease, screening them regularly can help protect them from TB disease. Screening can also identify if multiple children have been exposed to or contracted TB from an infected adult. 

Treatment and Management of TB in Children

Inactive TB Infection

Inactive TB infection still poses a risk for active infection. Children with inactive TB infection should be treated to prevent active infection or the spread of TB throughout the body and to other people. Your doctor will prescribe a treatment regimen. Depending on this regimen, TB treatment can take anywhere from a few months to longer. Medications can help prevent the infection from becoming active. 

Active TB Disease

Active TB disease requires aggressive treatment as soon as possible. Children who have active TB disease are at a higher risk of the condition progressing quickly. The treatment for this stage involves a multi-drug approach. The doctor will prescribe antibiotics and Directly Observed Therapy, where they will monitor the child receiving the treatment to ensure the regimen is thoroughly followed. The multi-drug approach ensures that certain strains of the TB bacteria do not become resistant to antibiotics. Active TB disease treatment takes a few months or longer.

Importance of adhering to the treatment regimen

It is absolutely crucial that your child completes the treatment according to the regimen. Stopping too early can result in the child becoming sick again or the TB becoming more aggressive. Treatment for TB in children has to be followed in the exact way it is recommended. Incorrectly taken medications can cause complications. Whatever strains of bacteria survive may become resistant to the medications.

Other Ways to Support TB Treatment

Nourishment matters in recovery from any illness. Our bodies lose many vital nutrients when we are sick. You can ensure your child receives the full effect of the treatment by preparing nutritious meals that support recovery and regain their strength.

Being sick can take a toll on one’s emotional and psychological well-being. Affected children and their families can benefit from undergoing therapy, regaining their sense of control over their health and overall lives. Children with TB can potentially ease their anxiety through therapy, too.

Knowledge is power; doctors and parents can empower children by helping them understand TB and its treatment methods. When children are actively involved in their care, they feel as much in control of their health as their parents. These ways can ensure the treatment regimen is followed completely and exactly.

Complications

Tuberculosis in children can be precarious. Due to their developing immune system, the disease can progress or spread quickly. This is why prompt medical response is required in the cases of TB in children. However, sometimes complications occur regardless of the response time or treatment regimen. Let's take a look at some complications that could potentially occur with TB in children:

• TB Meningitis

TB Meningitis is a life-threatening complication that arises from untreated or poorly treated TB. In TB Meningitis, the infection spreads to the meninges, the layers that protect the nervous system. Once the TB disease has reached your brain and spine, it is time for aggressive treatment. Timely intervention is crucial here to limit the damage to the patient's overall health. If poorly treated or untreated, TB Meningitis leads to severe disability or death.

• Lung Damage

Since TB typically starts in the lungs, the damage to this organ can be extensive. There is scarring, narrowing of the airways, and even cavities. Many patients experience what is called Post-Tuberculosis Lung Disease. Your lung capacity reduces, you feel a shortness of breath, and you become vulnerable to developing infections.

• Skeletal Tuberculosis

Skeletal tuberculosis refers to bone and joint damage due to tuberculosis. It is a serious complication that results from poorly treated or untreated tuberculosis. The TB bacteria spread to bones and joints, predominantly the ones in the hips, spine, and knees. Skeletal tuberculosis causes pain, swelling, and stiffness in the joints. If Skeletal TB is left untreated, it can potentially lead to permanent bone and joint damage or deformities.

Conclusion

Tuberculosis is a precarious condition. It is highly contagious and can spread to other people and throughout the body quickly, especially in children. Although tuberculosis is preventable and curable, it remains a global health concern. Children are at a higher risk of contracting TB, especially those under the age of 5.

Understanding the disease can help you prepare as parents of a child with TB. If you or another adult in the house has TB, your children are vulnerable to catching it. Knowing the symptoms, risks, and treatment options for a disease like TB can ensure you stay prepared in case there is a breakout. It also ensures early intervention, preventing serious complications.