Early Diagnosis and Treatment of Tuberculosis in Children

¹ William H. Maybury Sanatorium.

Every effort must be made to advance the diagnosis and management of early tuberculosis in children. The proper use of the tuberculin test will help do this. A positive tuberculin test is specific and is diagnostic of active tuberculosis in a child if he is very young, if it is preceded by a recent negative test, if it is associated with known contact with an "open" case of tuberculosis or if it is suported by clinical, x-ray film or laboratory findings.

The value of x-ray film in diagnosing early tuberculosis in children is definitely limited because it is difficult to obtain a good roentgenogram, the lesions may be obscured by intrathoracic structures, the shadows may be mistaken for other types of disease and because there is nothing specific about early primary tuberculosis lesions, the lesions may not have developed to the extent that they can be demonstrated by x-ray film.

Case history is extremely important including dates-dates of contact, of onset of symptoms, of negative and positive tuberculin tests and of negative and positive x-ray film findings. Among 335 children treated in Maybury Sanatorium since January 1, 1956, the age of onset was under five years in more than 75 per cent. These home infected children should serve as "pilots" in searching for "open" cases of tuberculosis. The source of contact was found among members of the family in 35 per cent and among other close relatives in 34 per cent of the cases. In 15 per cent the contact was an uncooperative tuberculous patient.

Symptoms are variable but not specific. Nearly 95 per cent of the 335 children had symptoms. Cases diagnosed in non-tuberculosis hospitals and clinics were more likely to have severe symptoms than those diagnosed in the tuberculosis clinic. Many children known to be exposed and/ or infected were treated for various other conditions before the real cause of illness was suspected. During these periods of time some of these childern progressed to serious tuberculosis-five such cases are presented. A plea is given to discard the routine three-month interval between checkup examinations in the management of early tuberculosis in children. Serious progression often occurs within three months.

Antimicrobial therapy must be used at the earliest possible time in tuberculosis in children\p=m-\i. e., when the tuberculin converts or if the child has had heavy exposure and is sick ( anergic). The younger or the sicker the child the more urgent is treatment. We use Isoniazid 7-6 mg./ Kg./ day with PAS 150-100 mg./ Kg./ day. It is tolerated well and no harm will result from its use in suspected cases but if not used and the child develops serious tuberculosis there is no way to recover the early advantageous point which was missed.

We urge that more attention be given to tuberculosis in young children. We advocate the tuberculin testing of all pre-school children in clinics and doctors' offices and the proper handling of all positive reactors. We recommend early treatment of all cases, in the hospital preferably for the initial part and in the properly organized home for the completion.