4.2 Diagnosing TB in children and adolescents

Young children have a higher risk of developing TB compared with other age groups (4). Risk of TB disease is more pronounced among children and adolescents who:

  • are a household or other close contact with a person with PTB, especially if bacteriologically confirmed;
  • are aged under 5 years;
  • are living with HIV, especially if poorly controlled;
  • have severe acute malnutrition (SAM), especially if not responding to nutritional rehabilitation;
  • are hospitalized with pneumonia, especially if not responding to antibiotic treatment.

Diagnosing TB in children and adolescents relies on a combination of (6):

  • careful history, including any TB contact (especially in the past 12 months), previous TB treatment,and signs and symptoms consistent with TB;
  • clinical examination, including growth assessment;
  • HIV testing if status unknown;
  • bacteriological testing (if available);
  • CXR (preferably anteroposterior and lateral in children aged under 5 years and posteroanterior in older children and adolescents);
  • TB infection testing (TST or IGRA);
  • investigations relevant for presumed EPTB.

A decision to start TB treatment based on clinical parameters should not be delayed if the necessary investigations are not available, particularly for children at higher risk of developing severe disease, such as those aged under 2 years, living with HIV, with SAM, or hospitalized with pneumonia (not responding to first-line treatment for pneumonia). A trial of treatment with TB medicines is not recommended as a method of diagnosing TB in children.

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