Tuberculosis - I.T. Pyatnochka 2005

Extrapulmonary tuberculosis
Tuberculous intoxication in children (tuberculosis without a defined localization)

Tuberculous intoxication (TI) is a clinical form of Primary tuberculosis characterized by a symptom complex of functional disorders, yet without any detectable local manifestations of the disease.

Pathomorphology. Tuberculous intoxication presents with minimal specific and paraspecific changes, primarily in enlarged Lymph Nodes, as well as in the Spleen, pulmonary interstitial tissue, Liver, and other Organs.

Clinical Features. A child's behavior frequently changes; they become irritable and emotionally labile, lose their cheerfulness, fatigue easily, and exhibit a reduced attention span, poorer appetite, and impaired memory. Sweating, occasional low-grade fever, and dyspeptic disorders may also appear.

Objective Examination reveals pallor, decreased Skin turgor, occasional paraspecific reactions (such as erythema nodosum, keratoconjunctivitis, blepharitis, or phlyctenules), and enlargement of peripheral lymph nodes.

Diagnosis. The diagnosis of tuberculous intoxication is based on tuberculin skin test conversion, symptoms of intoxication, the absence of changes on radiographs and tomograms, and the exclusion of intoxication of other etiologies. In doubtful cases, a trial course of anti-tuberculosis therapy lasting up to 3 months is recommended.

Differential diagnosis is performed with conditions such as chronic tonsillitis, helminthic infestation, hepatocholecystitis, Pyelonephritis, and others.

Treatment. Children and adolescents with a tuberculin skin test conversion undergo Chemoprophylaxis with isoniazid for 3 months and are monitored under dispensary observation group 5.4 for at least one year.

Treatment for children with tuberculous intoxication involves isoniazid combined with ethambutol or rifampicin for 4–6 months, provided that a sanatorium and hygienic regimen is maintained; Category 3 (Cat 3).