RNTCP

Guidelines
for TB
PRESENTATION BY DR MAYUR
C GWALANI
RNTCP Guidelines

▪ Pulmonary TB is the most common form in children but the

extrapulmonary TB forms a Large Proportion of case in adults.
▪ It is also known that about 10% of the cases reported to RNTCP
are from children under 14 years of age
▪ Natural history of disease
▪ TB Infection  Cannot Spread TB Bacteria to Others

▪ TB Disease  May Spread TB Bacteria to others

 Risk Factors for TB infection and disease in children

Title• and Content

For TB infection
Layout with Chart
• For TB disease

• Increased exposure • Young age

 Living in high TB endemic communities  Especially 0-2 years
 Children of families living with HIV
• HIV infection
 Overcrowding & poor sanitation condition
 Risk of infection and disease
 Air pollution including environmental
 Tobacco smoke
• Source case • Other immune-suppression
 Cavitary disease /Smear positivity  Malnutrition
 Cough frequency / Cough hygiene  Post-measles, post-viral
 Delay in treatment of adult case  Diabetes

• Lack of contact screening • Lack of prophylaxis

• Contact with source case • Not BCG vaccinated

 Closeness of contact  Risk of disseminated disease with increased
 Duration of contact severity
 Childhood TB Transition

▪ Infection to disease transition in children can be a continuum and

the distinction between the two is made on the basis of presence
of symptoms reaching the threshold of clinical significance.
IN PRIMARY INFECTION, CHEST RADIOGRAPH SHOWS PARATRACHEAL AND/OR HILAR
NODES. THERE CAN BE ASSOCIATED DIRECT SIGNS (AIRWAY NARROWING OR DEVIATION)
OR INDIRECT SIGNS OF AIRWAY COMPRESSION (COLLAPSE, EMPHYSEMA).
▪ Three features common to primary infection are
▪ (1) Patient may have non-specific mild symptoms which can go un-
recognized,
▪ (2) Primary lung foci are usually quite small relative to large hilar
nodes, and
▪ (3) Primary foci may resemble pneumonia & can be in any lobe
Parenchymal disease in primary TB typically involves areas of
greatest ventilation e.g. middle lobe, superior segments of lower
lobes, anterior segment of upper lobes.
PROGRESSION OF A PRIMARY TB TO PROGRESSIVE PRIMARY
DISEASE
Case Definitions TB

▪ Presumptive Paediatric TB:

 refers to children with persistent fever and/or cough for more than 2
weeks, loss of weight/no weight gain and/ or history of contact with
infectious TB cases

 In a symptomatic child, contact with a person with any form of active

TB within last 2 years may be significant.

History of unexplained weight loss or no weight gain in past 3 months;

loss of weight is defined as loss of more than 5% body weight as
compared to highest weight recorded in last 3 months.
• Presumptive Extra Pulmonary TB: refers to the presence of organ specific symptoms
and signs like
 swelling of lymph nodes,
 pain & swelling in joints,
 neck stiffness,
 Disorientation
 etc
And/or constitutional symptoms like
 significant weight loss,
 persistent fever for ≥2 weeks,
 night sweats.

• Presumptive DR TB: refers to those TB patients

 who have failed treatment with first line drugs,
 paediatric TB non-responders,
 TB patients who are contact of DR-TB (or Rif resistance).
 TB patients who are found positive on any follow up sputum smear examination
during treatment with first line drugs, previously treated TB cases, and, TB patients
with HIV co-infection.
 Diagnosis Of Tuberculosis

▪ Skin Test TB- Tuberculin Skin Test

▪ Chest Radiograph
▪ Ultrasonography & CT Scan
▪ Bacteriological Diagnosis
Smear For AFB
Gastric Aspirate
Induced Sputum
Bronchoscopy and Bronchioalveolar lavage
▪ CBNAAT
 TB Meningitis

▪ TBM most commonly presents in 6 months to 4 years age.

▪ Most severe form of TB in children and uniformly leads to
mortality, if not treated timely and effectively.
▪ Lymphohematogenous dissemination of the bacilli during the
initial infection leads to formation of caseous lesions in the
meninges/cerebral cortex.
▪ Caseous lesions (Rich focus) discharges bacilli in the subarachnoid
space and produces exudates.
CECT HEADS IS THE INITIAL MODALITY OF DIAGNOSIS. IT MAY HAVE ONE OR MORE OF BASAL
MENINGEAL ENHANCEMENT, HYDROCEPHALUS, TUBERCULOMA, INFARCTS IN DIFFERENT AREAS,
ESPECIALLY THE BASAL GANGLIA AND PRE-CONTRAST BASAL HYPER DENSITY. IT SOMETIMES EVEN
FOUND NORMAL. CONTRAST MRI HAS HIGHER SENSITIVITY THAN CECT FOR THE ABNORMALITIES
SUCH AS MENINGEAL ENHANCEMENTS, INFARCTS AND TUBERCULOMAS ESPECIALLY OF LESIONS
INVOLVING THE BRAINS STEMS
Algorithm for diagnosis of TBM
THANK YOU