<prompt> True about Tuberculosis in children-Commonly sputum negativeIncidence 5-15 of all TB casesClinically child does not show sign of florid TBAll of the above  <response>: Ans. is di.e., All of above Tuberculosis in children y Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, y Cases of tuberculosis represent 5-15 percent of all tubercular cases. Clinical manifestations of TB in children y The majority of children with tuberculosis infection develop no signs or symptoms at any level. y Occasionally, infection is marked by low-grade fever, mild cough, malaise and flu-like symptoms. A Primary pulmonary disease The lung is the portal of entry in 98 of cases. The primary complex of tuberculosis includes local infection at the portal of entry and regional lymph nodes that drain the area. The combination of the parenchymal pulmonary- lesion and corresponding lymph node is called Ghon complex. Asymptomatic pleural effusion is so frequent in primary- tuberculosis that it is basically a component of the primary complex. - Nelson It may have one of the following course : - Heating by fibrosis and calcification. Progressive primary tuberculosis. Cavity Obstructive emphycema y If incomplete obstruction is caused by lymph nodes. Resorption atelectesis y If complete obstruction is caused by lymph nodes. Tubercular bronchits brionchiactasis Hematogenous dissemination During early bacteremia seeding may occur at apex Simons focus. Miliary tuberculosis Collapse consolidation segmental lesion A combination of pneumonitis and atelectasis. B Chronic pulmonary tuberculosis Infrequent in young children Children above the age of seven years, especially girls are more vulnerable. Commonest site of chronic pulmonary tuberculosis is the apex of lung Puhls lesion. Infraclavicular lesion of chronic pulmonary tuberculosis is called Assmans focus. Regional lymph nodes are not involved in chronic pulmonary TB in contrast to primary TB. Lab investigations of pediatric TB o ESR and blood counts : No value in diagnosis or follow up of TB. o Demonstration of AFB : o Children dont expectorate out sputum, but swallow it. Therefore sputum is not available for examination. o A laryngeal swab may be obtained for smear and culture examination for mycobacteria o It is customer to examine the gastric lavage in children for bacteriological examination on 3 consecutive days, o Aspiration of early morning gastric contents before breakfast is done with a ryles tube and sent for bacteriological examination. Adding vancomycin to the sample improves the yield of mycobacterium. o The CSF, Pleural fluid or bronchial aspirate, urine and discharges from tuberculous sinuses are examined for tubercle bacilli. o Histopathology : Material for histopathology may be obtained by biopsy or FNAC. o PCR : High sensitivity and specificity for pleural fluid and low for gastric aspirate, o CXR and CT may show characterstic features. o USG may be helpful for detection of enlarged abdominal lymph nodes, o Serology : Elisa or other methods have no utility in pediatric TB. Antitubercular drugs used in children First line drugs : Isoniazid, Rifampicin, EthambutoL Streptomycin, Pyrazinamide Second line drugs : Cycloserine, Ethionamide, PAS, Capreomycin, Kanamycin Other drugs. Quinolones Ofloxacin, Rifamycin, Amikacin, Imipenem, Ampicillin 