Tuberculosis Study Guide - M. M. Savula 2002

Primary tuberculosis in children
Tuberculous intoxication in children

If a child or adolescent develops symptoms of intoxication simultaneously with tuberculin conversion that cannot be explained by other diseases, and a detailed examination reveals no tuberculous Changes in the respiratory Organs or other systems, a Diagnosis of tuberculous intoxication is established.

These children exhibit weakness, decreased appetite, intermittent low-grade fever, sweating, and irritability.

Examination of the child may reveal pale Skin, malnutrition, and sometimes paraspecific manifestations such as Conjunctivitis, blepharitis, and erythema nodosum (painful, reddish-cyanotic nodules, most commonly on the shins). Slightly enlarged peripheral Lymph Nodes (in more than 5 groups, especially cervical) are often palpated; they are soft-elastic and painless. This symptom is commonly referred to as micropolyadenitis. Sometimes, a slightly enlarged Liver is palpated in younger children. Over the Lungs, Percussion sounds are unchanged, and vesicular breathing is heard.

A complete Blood count shows normal or slightly elevated ESR, lymphopenia, and sometimes mild leukocytosis. A recent tuberculin conversion, sometimes a hyperergic reaction to the Mantoux test, and a history of contact with a tuberculosis patient are of great diagnostic importance. Children with tuberculous intoxication often suffer from acute and chronic non-specific Inflammatory Diseases, especially of the Respiratory system, which complicates diagnosis.

X-ray Examination reveals no changes in the lungs or hilar lymph nodes. A detailed examination of the child also shows no tuberculous changes in other organs.

Thus, tuberculous intoxication is understood as a complex of pathological disorders resulting from primary infection of a child with Mycobacterium tuberculosis, without detectable local tuberculous changes in the lungs, hilar lymph nodes, or other organs.

Therefore, the diagnostic criteria for this form of tuberculosis are:

♦ symptoms of intoxication;

♦ recent tuberculin conversion;

♦ absence of tuberculous changes in the lungs and hilar lymph nodes on X-ray or tomogram;

♦ exclusion of intoxication of other etiologies.

Tuberculous intoxication is believed to be caused by minimal tuberculous changes in The Lymphatic system (most commonly in the intrathoracic lymph nodes).

If tuberculous intoxication is diagnosed more than a year after tuberculin conversion, or if it lasts for more than a year, it is called chronic. It is accompanied by physical developmental delay and malnutrition. Peripheral lymph nodes become firm. Nowadays, chronic tuberculous intoxication develops very rarely, occurring in children from tuberculosis foci with poor sanitary standards and difficult living conditions.

Children with tuberculous intoxication undergo anti-Tuberculosis Treatment in a hospital or sanatorium Setting.