PRIMARY COMPLEX in children Symptoms

In the first stage of tuberculosis in a child, the bacteria infect the lungs. At this point, the bacteria may remain latent. In rare cases, the child's immune system may be strong enough at this point to fight the infection,. Four or five months later, in the next stage, the main symptoms of tuberculosis become apparent. These include pneumonia, liquid on the lungs, and collapse of the lungs. More apparent symptoms include weight loss and heavy coughing. There are no apparent symptoms in the final stage, but the bacteria are usually still present in the lungs and may cause another infection.

Diagnosis
Tuberculosis is difficult to diagnose in children because a lot of the methods used to diagnose the disease, such as chest radiographs, have difficulty distinguishing tuberculosis in a child from other chest and lung infections, such as pneumonia. Testing the sputum coughed up by a child is the most reliable method of diagnosing the disease, but this is complicated by the fact that most children cannot produce the amount of sputum needed for the test. Because of these factors, tuberculosis in children is often diagnosed by identifying the symptoms.

Treatment
It takes a long time to kill the bacteria that lead to tuberculosis. For this reason, it is important to begin treatment as quickly as possible. The drug combinations used to cure tuberculosis in adults are used in smaller doses for children and include drugs such as ethambutol, isoniazid, pyrazinamide, rifampicin and streptomycin. Almost 90 percent of the bacteria are killed within the first two weeks of treatment, according to Kenyon College. However, treatment must be continued for six months to kill the remaining 10 percent. If treatment is not continued then there is a high risk of the re-infection. Drugs and its actions 1. Rifampicin: Rifampicin is typically used to treat Mycobacterium infections, including tuberculosis and leprosy; INDICATION: Rifampicin was introduced in 1967, as a major addition to the cocktail-drug treatment of tuberculosis and inactive meningitis, along with isoniazid, ethambutol, pyrazinamide andstreptomycin. It requires a prescription in North America. It must be administered regularly daily for several months without break; otherwise, the risk of drug-resistant tuberculosis is greatly increased. In fact, this is the primary reason that it is used in tandem with the three aforementioned drugs, particularly isoniazid. This is also the primary motivation behind directly observed therapy for tuberculosis. Rifampicin resistance develops quickly during treatment and rifampicin monotherapy should not be used to treat these infections it should be used in combination with other antibiotics. ACTION: Rifampicin inhibits DNA-dependent RNA polymerase in bacterial cells by binding its beta-subunit, thus preventing transcription to RNA and [10] subsequent translation to proteins. Its lipophilic nature makes it a good candidate to treat the meningitis form of tuberculosis, which requires distribution to the central nervous system and penetration through the blood-brain barrier. ADVERESE EFFECT: The most serious adverse effect is related to rifampicin's hepatotoxicity, and patients receiving rifampicin often undergo baseline and frequentliver function tests to detect liver damage. CONTRAINDICATION: Acute, closed-angle glaucoma, Asthma, history of bronchiospasm or obstructive airways disease, Epilepsy, Pre-existing heart conditions (e.g., myocardial infarction), Severely compromised liver and/or renal function, Metabolic acidosis, as in diabetes 2. Isoniazid: Isoniazid is a first-line antituberculous medication used in the prevention and treatment of tuberculosis. INDICATION: Isoniazid is used in the treatment of tuberculosis in the lungs and elsewhere in the body in combination with other anti-tuberculosis drugs. SIDE EFFECTS:The most common side effect seen with use of Isoniazid is peripheral neuropathy, which is characterised by loss of

sensation, tingling and difficulty moving in the extremities.Hepatitis is also seen, with rates increasing with age. Symptoms to look out for include:- fatigue- weakness- malaise- loss of appetite- nausea- vomitingThere are other side effects that may be seen including:- feverskin rash ACTION: Isoniazid is an antibacterial agent active only against Mycobacteria, the bugs that cause tuberculosis. Its mechanism of action is unclear, but it may act by inhibiting formation of the mycobacterial cell wall. Resistance to Isoniazid alone develops quickly in individual patients, so it should always be given in combination with other anti-tuberculosis agents.
ADVERSE EFFECT: include rash, abnormal liver function tests, hepatitis, sideroblastic anemia, high anion gap metabolic acidosis, peripheral neuropathy, mild central nervous system (CNS) effects, drug interactions resulting in increased phenytoin (Dilantin) or disulfiram (Antabuse) levels and intractable seizures (status epilepticus). CONTRAINDICATION: Isoniazid is contraindicated in patients who develop severe hypersensitivity reactions, including drug -induced hepatitis; previous isoniazid-associated hepatic injury; severe adverse reactions to isoniazid such as drug fever, chills, arthritis; and acute liver disease of any etiology. 3. Pyrazinamide: Pyrazinamide is a drug used to treat tuberculosis in afflicted patients. The drug is largely bacteriostatic, but can be bacteriocidal on actively replicating tuberculosis bacteria. ACTION: Pyrazinamidase converts pyrazinamide to the active form, pyrazinoic acid which accumulates in the bacilli. Pyrazinoic acid was thought to inhibit the enzyme fatty acid synthase (FAS) I, which is required by the bacterium to synthesise fatty acids[7] although this has been discounted. It was also suggested that the accumulation of pyrazinoic acid disrupts membrane potential and interferes with energy production, necessary for survival of M. tuberculosis at an acidic site of infection. SIDE EFFECTS: The most common (approximately 1%) side effect of pyrazinamide is joint pains (arthralgia), but this is not usually so severe that patients need to stop taking the pyrazinamide. The arthralgia can be distressing to patients, but is never harmful. ADVERSE EFFECT: Fever, porphyria and dysuria have rarely been reported, Hepatotoxicity appears to be dose related, and may appear at any time during therapy. GI disturbances including nausea, vomiting and anorexia have also been reported. Mild arthralgia and myalgia have been reported frequently. Hypersensitivity reactions including rashes, urticaria, and pruritis have been reported. Fever, acne, photosensitivity, porphyria, dysuria and interstitial nephritis have been reported rarely. INDICATION: For the initial treatment of active tuberculosis in adults and children when combined with other antituberculous agents.