In children and adolescents, severity of TB disease ranges from mild to severe. Children with nonsevere, drug-susceptible TB are now eligible to receive a shortened 4-month treatment regimen. For consideration of a 4-month treatment regimen for non-severe, drug-susceptible PTB in children and young adolescents aged 3 months to 16 years, non-severe TB is defined based on the clinical presentation of disease as assessed through physical examination and CXR. All children who have a decision to treat for PTB based on the treatment decision algorithms should be assessed for disease severity. This assessment should not delay treatment initiation, as disease severity will only impact on the duration of the continuation phase.
Non-severe TB is defined as peripheral lymph node TB; intrathoracic lymph node TB without airway obstruction; uncomplicated TB pleural effusion (without empyema or pneumothorax); or paucibacillary, non-cavitary disease confined to one lobe of the lungs and without a miliary pattern (evaluated on CXR). Severe disease in children and young adolescents is usually defined by the presence of cavities or bilateral disease on CXR (82).
More details regarding determination of severity of disease when CXR or Xpert MTB/RIF or Ultra is not available can be found in Chapter 5 on treatment.