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d55b8c4d00144879b07df14c84b05258 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Treatment Guidelines for Children and Adolescents | The battle against tuberculosis (TB) remains one of the most significant challenges for our nation, particularly concerning our youngest and most vulnerable populations—children. Many advances have been made in managing TB in children and adolescents over the past decade, leading to important progress and new knowledge... | The battle against tuberculosis (TB) remains one of the most significant challenges for our nation, particularly when it comes to our youngest and most vulnerable populations -children. Many advances have been made in managing TB in children and adolescents over the past decade, which have led to important progress and... | ACCEPT | train |
626b0f768ef14b559934a78a2c46bc64 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Combating Tuberculosis in South Africa | We thank you for reviewing the evidence used in these guidelines. As you explore these revised guidelines, we encourage all stakeholders—from healthcare providers to public health officials, educators, and community leaders—to engage with and actively implement these recommendations. Together, we can strengthen our res... | also thanked for reviewing the evidence used in these guidelines. As you delve into these revised guidelines, we encourage all stakeholders-from healthcare providers on the ground to public health officials, educators and community leaders-to engage with and implement these recommendations actively. Together, we can st... | REJECT | train |
c280a34174894ba48610952aaa529370 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Pediatric Tuberculosis Epidemiology and Treatment Gaps | The World Health Organization (WHO) estimated that approximately 1.25 million children aged 0-14 years developed tuberculosis (TB) globally in 2022. Of these, only 612,800 children were notified and reported by TB programs to WHO as diagnosed and treated, leaving 51% undiagnosed, untreated, and/or not reported. The TB ... | The World Health Organization (WHO) estimated that approximately 1.25 million children aged 0-14 years developed tuberculosis (TB) globally in 2022. 1 Of these, only 612,800 children were notified and reported by TB programmes to WHO as diagnosed and treated, leaving half (51%) undiagnosed, untreated and/or not reporte... | ACCEPT | train |
90628716bd72449181ef120999e185b7 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Post-TB Care in Children and Adolescents | For adults, bacteriological confirmation is more likely in adolescents, who often have adult-type (cavitary) pulmonary tuberculosis (PTB) disease. | that for adults. • Bacteriological confirmation is more likely in adolescents, who often have adult-type (cavitary) PTB disease. | ACCEPT | train |
6ae2c00ab4234924b3c683f08b306577 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Specimen Collection and Radiological Findings | Specimen collection is more difficult and technical, such as gastric aspirates. Different pathologies produce different radiological pictures on chest X-rays. | Specimen collection is more difficult and more technical, e.g. gastric aspirates. • Different pathology produces a different radiological picture on chest x-rays. | ACCEPT | train |
b9ccddd0abe343268e7d387cba85db99 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Timely Treatment and Outcomes in Children | Children have very good outcomes if started on appropriate treatment in a timely manner, but they face the highest risk of poor outcomes if not treated. | Children have very good outcomes if started on appropriate treatment timeously, but the highest risk of poor outcomes if not treated. | ACCEPT | train |
0af8a503e71e4871b72999bc926d930c | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Pathophysiology of TB in children | Children usually develop TB after inhaling droplet nuclei containing Mycobacterium tuberculosis (M. tb), which have been coughed or breathed out by another person with infectious TB disease, typically an adult or older child known as "the source patient." Droplet nuclei can remain in the air for several hours. When a c... | Children usually develop TB after inhaling droplet nuclei containing Mycobacterium tuberculosis (M. tb), which have been coughed or breathed out by another person with infectious TB disease. This person is usually an adult or older child and can be called "the source patient". Droplet nuclei can remain in the air for s... | ACCEPT | train |
d3f70329058f41afa8651f9317f6018b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Significant TB Exposure | A history of significant exposure to a TB source patient is defined as: "Exposure, within the 12 months before the child or adolescent presents with presumed TB, to a person (adult or adolescent) with pulmonary TB, within the same enclosed space for ≥ 1 night (e.g., at home) or for frequent or extended daytime periods ... | A history of significant exposure to a TB source patient is defined as: "Exposure, within the 12 months before the child/adolescent presents with presumed TB, to a person (adult or adolescent) with pulmonary TB, within the same enclosed space for ≥ 1 night (e.g. at home or similar) or for frequent or extended daytime p... | ACCEPT | train |
5a4dae31d4aa44a39296692814a80c5a | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Infection | A state of persistent immune response to stimulation by Mycobacterium tuberculosis (M.tb) antigens, with no evidence of clinical TB disease, is referred to as "TB infection," distinct from "TB disease." Most infected individuals have no signs or symptoms of TB but are at risk for developing TB disease. The term "latent... | A state of persistent immune response to stimulation by Mycobacterium tuberculosis (M.tb) antigens with no evidence of clinical TB disease is referred to as "TB infection," distinct from "TB disease." Most infected people have no signs or symptoms of TB but are at risk for TB disease. The term "latent TB" has been repl... | ACCEPT | train |
577fd6e42eaf4263b3b25690c737d86d | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Presumptive TB | A child or adolescent is considered to have presumptive TB when tuberculosis is a possible cause of illness in individuals presenting with symptoms or signs suggestive of TB. | A child or adolescent is believed to have presumptive TB when TB is considered a possible cause of illness in those who present with symptoms or signs suggestive of TB. | ACCEPT | train |
e3301846df69422791a3771811313a42 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Pulmonary Tuberculosis Overview | Pulmonary tuberculosis (PTB) refers to tuberculosis involving the lung tissue, airways, or draining lymph nodes, indicated by mediastinal and/or hilar lymph node enlargement on chest X-ray (CXR). PTB can be either clinically diagnosed or bacteriologically confirmed. | Pulmonary tuberculosis (PTB) refers to TB involving the lung tissue, airways or draining lymph nodes (indicated by mediastinal and/or hilar lymph node enlargement on CXR). PTB is either clinically diagnosed or bacteriologically confirmed. | ACCEPT | train |
ab37a575810c4f46a17570ef9fec8ff4 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Extrapulmonary TB | Any bacteriologically confirmed or clinically diagnosed patient with tuberculosis (TB) involving organs other than the lungs, airways, and intrathoracic lymph nodes. | Any bacteriologically confirmed or clinically diagnosed patient with TB involving organs other than the lungs, airways and intrathoracic lymph nodes. | ACCEPT | train |
f58907bc0ca946c6a00aeec0326341c8 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Management of Drug-Resistant Tuberculosis | M. tb strains that are resistant to first-line anti-TB drugs.
**Overview of the TB Diagnostic and Management Process**
Figure 2 provides an overview of the TB diagnostic and management process. The same process of screening, assessing/evaluating for TB disease, making a diagnosis, and treating and managing the diagn... | M.tb strains that are resistant to first-line anti-TB drugs. 5 Overview of the TB diagnostic and management process Figure 2 provides an overview of the TB diagnostic and management process. The same process of screening, assessing/evaluating for TB disease, making a diagnosis, and treating and managing the diagnosis a... | ACCEPT | train |
1ec7e4eeec864f9b89a357b4e639e619 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Treatment Response and DST Results | Review response to treatment, and genotypic and phenotypic DST results to determine
the final regimen composition and duration | TB disease excluded Possible TB Infection Diagnosis Treatment Review response to treatment, and genotypic and phenotypic DST results to determine | ACCEPT | train |
66b2fbb1dadc43cd99d3bad5cd0063cb | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Treatment Regimen and Duration | Determine the starting regimen and duration of treatment based on clinical, radiological, and microbiological disease severity, including resistance patterns (in the child or in the TB source case), if available. | Determine the starting regimen and duration of treatment based on clinical, radiological, and microbiological disease severity, including resistance patterns (in child or in TB source case), if available. | ACCEPT | train |
8e09af01c7ff4db1955203150ba1054b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Diagnosing TB in Children and Adolescents | Diagnosing TB in children and adolescents relies on an assessment of a combination of components or "puzzle pieces." These include:
- Patient history, including recent TB exposure and symptoms consistent with TB.
- Clinical examination, including growth assessment.
- HIV status (test if HIV status was negative at the... | Diagnosing TB in children and adolescents relies on an assessment of a combination of components or "puzzle pieces". These include: • Patient history, including recent TB exposure and symptoms consistent with TB. • Clinical examination, including growth assessment. • HIV status (test if HIV status was negative at last ... | ACCEPT | train |
2bbd0c4415ed46108bc70947bf873644 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Signs Indicating Urgent Medical Attention in Children | General danger signs:
- Unable to drink or breastfeed
- Vomiting everything
- Convulsions
- Unconscious or lethargic
- Any signs of shock
Signs of severe respiratory illness (any of the following):
- Chest indrawing
- Stridor in a calm child
- Oxygen saturation < 92% on room air
- Central cyanosis ... | General danger signs • Unable to drink or breastfeed • Vomiting everything • Convulsions • Unconscious or lethargic • Any signs of shock Signs of severe respiratory illness (any of the following) • Chest indrawing • Stridor in calm child • Oxygen saturation < 92% on room air • Central cyanosis Signs of severe dehydrati... | ACCEPT | train |
e69c72cb4a7247738ae6d8378865025b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Identifying TB Exposure in Children and Adolescents | A history of significant exposure to a TB source patient is defined as: "Exposure, within the 12 months before the child or adolescent presents with presumed TB, to a person (adult or adolescent) with pulmonary TB within the same enclosed space for ≥ 1 night (e.g., at home) or for frequent or extended daytime periods (... | A history of significant exposure to a TB source patient is defined as: "Exposure, within the 12 months before the child/adolescent presents with presumed TB, to a person (adult or adolescent) with pulmonary TB within the same enclosed space for ≥ 1 night (e.g. at home or similar) or for frequent or extended daytime pe... | ACCEPT | train |
60f1a60277b24f70aa1edaa147e4fa11 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Symptoms of Pulmonary Tuberculosis in Children | - Cough of any duration, especially if persistent and failing to improve.
- Loss of appetite.
- Failure to thrive or weight loss.
- Fatigue, reduced playfulness, lower activity levels.
- Prolonged fever and/or drenching night sweats.
Most children and adolescents with TB develop unremitting symptoms that persist ... | • Cough of any duration, but especially if it is persistent and fails to improve. • Loss of appetite. • Failure to thrive or weight loss. • Fatigue, reduced playfulness, lower activity levels. • Prolonged fever and/or drenching night sweats. Most children and adolescents with TB develop unremitting symptoms that persis... | ACCEPT | train |
71d1d5ba2b41405faf53ce13f39473f7 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Post-Treatment Tuberculosis Follow-Up | Two years after completing tuberculosis treatment. | two years after completing TB treatment. | ACCEPT | train |
b9cfb2c7cf984f959c0d2382eae20dae | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Symptoms of extrapulmonary TB | Symptoms of extrapulmonary TB depend on the site of the disease, as detailed in Table 3 on page 10.
**Table 3: Additional Symptoms and Signs Related to Extrapulmonary TB**
**Site of EPTB: TB Meningitis (TBM)**
- The onset of TBM is often insidious, with symptoms usually present for days to weeks at diagnosis.
- E... | Symptoms of extrapulmonary TB will depend on the site of the disease, as detailed in Table 3 on page 10. Table 3 Additional symptoms and signs related to extrapulmonary TB Site of EPTB TB symptoms TB Meningitis (TBM) • The onset of TBM is often insidious, with symptoms usually present for days to weeks at diagnosis. • ... | ACCEPT | train |
dfda66b2c7e0468ba3787174ff806d1a | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Lymphadenitis | New lumps, often in the cervical (neck) area, are typically asymmetrical, painless, present for more than two weeks, and do not respond to antibiotics. Lymph nodes are often visible and may or may not be associated with a discharging sinus. | New lumps (often in the cervical (neck) area) are typically asymmetrical, painless, present for more than two weeks, and do not respond to antibiotics. Lymph nodes are often visible and may or may not be associated with a discharging sinus. | ACCEPT | train |
443d25c61cad428e94948636b2420198 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Assessment and Management of Failure to Thrive | The child should be weighed accurately, and the weight should be recorded in the weight-for-age curve in the child's RTHB. Weight should be compared to previous weights recorded in the past three months in the RTHB.
Failure to thrive can be defined as any of the following:
- Insufficient gain: clear deviation from th... | The child should be weighed accurately, and the weight should be recorded in the weight-for-age curve in the child's RTHB. Weight should be compared to previous weights in the past three months as recorded in the RTHB. Failure to thrive can be defined as any of the following: • Insufficient gain: clear deviation from p... | ACCEPT | train |
982173e203dd4f9f9a9405335b566813 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Signs of Respiratory Distress in Children | Respiratory System: The child may exhibit signs of respiratory distress, such as fast breathing, chest indrawing, head nodding, and grunting. These are danger signs; provide oxygen and manage according to the Integrated Management of Childhood Illness (IMCI) guidelines. Auscultation and percussion are typically normal ... | Respiratory system • The child may have signs of respiratory distress, such as fast breathing, chest indrawing, head nodding, and grunting. These are danger signs: provide oxygen and manage as per the Integrated Management of Childhood Illness (IMCI) guidelines. • Auscultation and percussion are usually normal but may ... | ACCEPT | train |
45eb4c0f8e1441bb87f13b8f6b28a6a2 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Signs of Tuberculosis in Respiratory Symptoms | - Asymmetrical and persistent wheeze not responsive to bronchodilator therapy, associated with other typical features of TB.
- Reduced air entry on one side of the chest, with either hyperinflation or collapse.
- Pleural effusion (reduced breath sounds and stony dull percussion).
- Pneumonia/parenchymal changes (crackl... | • asymmetrical and persistent wheeze not responsive to bronchodilator therapy and associated with other typical features of TB. • reduced air entry on one side of the chest with either hyperinflation or collapse. • Pleural effusion (reduced breath sounds and stony dull percussion). • Pneumonia/parenchymal changes (crac... | ACCEPT | train |
2815b86c03034fa18445afd33e02f007 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Lymphatic system | - TB adenitis may or may not be associated with other symptoms of TB.
- The cervical lymph nodes are the most common site of clinical presentation. The usual age of presentation is 2-10 years.
- Lymph node enlargement due to TB is typically:
- Large (>2 x 2 cm) and visibly enlarged (not just palpable).
- Painless, ... | • TB adenitis may or may not be associated with other symptoms of TB. • The cervical lymph nodes are the most common site of clinical presentation. The usual age of presentation is 2-10 years. • Lymph node enlargement due to TB is typically: o Large (>2 x 2 cm), and visibly enlarged (not just palpable). o Painless, fir... | ACCEPT | train |
b059683962374d73bd7ffa7c94423bcd | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Investigations | • Every effort should be made to establish bacteriological confirmation of pulmonary and extrapulmonary TB and drug susceptibility, even in young children.
• A respiratory sample should be obtained regardless of the presumed site of TB, even in cases of presumed extrapulmonary TB, unless bacteriological confirmation ... | • Every effort should be made to establish bacteriological confirmation of pulmonary and extrapulmonary TB and drug susceptibility, even in young children. • Every effort should be made to obtain a respiratory sample, regardless of the presumed site of TB and even if there is presumed extra-pulmonary TB, except if bact... | ACCEPT | train |
94e7db3d7a4a49e2a14e329b5d25385b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Investigations | - To receive antiretroviral treatment (ART) and routine viral load monitoring and management to achieve viral suppression.
- To receive comprehensive, integrated, and family-centered care for TB/HIV coinfection (see Section 12 on page 58).
The approach to diagnosing TB in children living with HIV (CLHIV) is similar ... | Section 6.5 on page 28). • To receive antiretroviral treatment (ART) and routine viral load monitoring and management to achieve viral suppression. • To receive comprehensive, integrated and family-centred care for TB/HIV coinfection (see Section 12 on page 58). The approach to diagnosis of TB in CLHIV is similar to th... | ACCEPT | train |
67f1822ac8c54fc8b7dfddb2922b47fa | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Tests available for TB diagnosis | **Table 5: Overview of Available Tests to Diagnose TB**
| TB Investigation | Purpose | TAT | Possible Outcomes |
|------------------|---------|-----|-------------------|
| **Tests for TB Infection** | | | |
| Tuberculin Skin Test (TST) | Confirmation of TB infection when TB exposure status is unknown (and no previous ... | Table 5 Overview of available tests to diagnose TB TB Investigation Purpose TAT Possible outcomes Tests for TB Infection Tuberculin Skin Test (TST) Confirmation of TB Infection when TB exposure status is unknown (and no previous positive TST or history of TB disease) 48-72 hours Positive if ≥10 mm, or ≥5 mm in a CLHIV ... | ACCEPT | train |
32fb414f6bf64338943c1c51e3bd53f6 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Extended Phenotypic DST | Identifies susceptibility to multiple TB drugs used to construct a rescue regimen. This information is obtained through an email request to the laboratory when a RR-TB regimen fails, if resistance to BDQ or LZD has been detected, or if the patient has been previously exposed to second-line drugs.
**Table 6: TB Investi... | Identifies susceptibility to multiple TB drugs used to construct a rescue regimen. Obtained by means of an email request to the laboratory when a RR-TB regimen fails, if resistance to BDQ or LZD has been detected, or if the patient has been previously exposed to second-line drugs. Table 6 The 'What', 'When' and 'How' f... | ACCEPT | train |
7fa0d8f4c93a485e97515335e70776f8 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Extended Phenotypic DST | **Test (TST)**
A positive TST confirms that a child has been infected with TB, now or in the past. A negative TST does not exclude TB infection or TB disease. A positive TST result does not differentiate between TB infection and TB disease. A TST provides no additional information on a child who is already known to h... | Test (TST) A positive TST confirms that a child has been infected with TB, now or in the past. A negative TST does not exclude TB infection or TB disease. A positive TST result does not differentiate between TB infection and TB disease. A TST provides no additional information on a child who is already known to have TB... | ACCEPT | train |
bebcc4a62b884ef59d44ee9c2d7398d0 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Extended Phenotypic DST | started without bacteriological confirmation. TB NAAT should be prioritized over TB culture in a sample with limited volume due to the speed of results. Potential samples include sputum, induced sputum, gastric aspirates, nasopharyngeal aspirates, and stool. Note: stool samples cannot be cultured. Tracheal aspirates an... | started without bacteriological confirmation. TB NAAT should be prioritised over TB culture in a sample with limited volume due to the speed of results. Potential samples include sputum, induced sputum*, gastric aspirates, nasopharyngeal aspirates and stool. Note: Stool samples cannot be cultured. Tracheal aspirates an... | ACCEPT | train |
7b345888f59745c1be0a940048ac6cf5 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Extended Phenotypic DST | Not a priority investigation in younger children who rarely have cavities. Younger children, particularly those under six, often cannot expectorate adequately. In these patients, induced sputum (induction with nebulized salbutamol followed by nebulized hypertonic saline and nasopharyngeal aspiration), gastric aspirate,... | not a priority investigation in younger children who rarely have cavities. *Younger children, particularly those under six, often cannot expectorate adequately. In these patients, induced sputum (induction with nebulised salbutamol followed by nebulised hypertonic saline and nasopharyngeal aspiration) OR gastric aspira... | ACCEPT | train |
b4c588048d624216ae2e405d843b1373 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Chest X-rays in Pediatric Tuberculosis Diagnosis | • CXR is an important tool for diagnosing pulmonary tuberculosis (PTB) in children, many of whom are bacteriologically negative or unable to produce sputum.
• CXR is also important in determining the severity of pulmonary disease to make treatment decisions for shorter 4-month regimens in patients with non-severe TB.... | • CXR is an important tool for diagnosing PTB in children, many of whom are bacteriologically negative or unable to produce sputum. • CXR is also important in determining the severity of pulmonary disease to make treatment decisions for shorter 4-month regimens in patients of non-severe TB. • CXR is very useful in iden... | ACCEPT | train |
3db90f8e4d1f454fbb4f6a2dc6167de9 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | CXR abnormalities seen in children with PTB | This CXR was taken from a 7-year-old child showing a left-sided pleural effusion. Additionally, there is evidence of underlying lung parenchymal disease, indicating radiologically severe disease. The CXR shows fine, millet-sized nodules typically seen in miliary TB. The nodules are of similar size and evenly spread thr... | This CXR was taken from a 7-year-old child showing a left-sided pleural effusion. In addition, there is the appearance of underlying lung parenchymal disease. This indicates radiologically severe disease. This CXR shows fine millet-sized nodules typically seen in miliary TB. The nodules are all of similar size and even... | ACCEPT | train |
770ec085fd9f4cc8b647098fd2571134 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Treatment Decision Algorithm | Now that we have examined the specific details of each component in the preceding text, the TB Treatment Decision Algorithm in Figure 6 on page 29 will assist us in interpreting all the components together to determine whether to initiate treatment for TB. | Now that we have looked at the specific details of each puzzle piece in the preceding text, the TB Treatment Decision Algorithm in Figure 6 on page 29 will help us interpret all the puzzle pieces together to decide whether to treat for TB or not. | ACCEPT | train |
859438e82fac48379355a71579b17f4e | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Diagnosis and Treatment Scoring Tool | The symptom scoring tool in the TB Treatment Decision Algorithm (Figure 6, page 29) aims to facilitate TB diagnosis, particularly at the PHC level, where CXR and bacteriological testing may not be readily available. It includes only the signs and symptoms section based on the child's clinical history and physical exami... | The symptom scoring tool in the TB Treatment Decision Algorithm in Figure 6 on page 29 aims to facilitate TB diagnosis, particularly at the PHC level, where CXR and bacteriological testing may not be readily available. It features only the signs and symptoms section based on the child's clinical history and physical ex... | ACCEPT | train |
4e1319fe55b14431afd031cc688df1c5 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Initiating TB Treatment in High-Risk Children | To start, TB treatment should not be delayed if the necessary investigations are not available, particularly in children at higher risk of developing severe disease, such as young children, malnourished children, or those living with HIV. If sufficient clinical or radiological evidence suggests TB, treatment may be sta... | to start TB treatment should not be delayed if the necessary investigations are not available, particularly in children at higher risk of developing severe disease, such as young children, malnourished children or those living with HIV. If sufficient clinical or radiological evidence suggests TB, treatment may be start... | ACCEPT | train |
7305fe4a08fa4f9ea54dc89fb95dca7e | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Follow-Up on TB Testing and Treatment | Follow up on any culture and DST results for the child, as applicable. If TB is excluded and symptoms resolve, offer TPT if eligible. | Follow-up on any culture and DST results of the child, as applicable If TB excluded and symptoms resolve offer TPT if eligible. | ACCEPT | train |
073fffc38aa84bb796bbe6aae63d8f68 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Treatment Guidelines for Children | Determine the starting regimen and duration of treatment based on clinical, radiological, and bacteriological disease severity, as well as the most likely drug susceptibility profile. Notify even if there is no microbiological confirmation. Screen for TB symptoms and TB exposure in all children at every healthcare enco... | Determine the starting regimen and duration of treatment based on clinical, radiological, and bacteriological disease severity, and most likely drug susceptibility profile. Notify even if no microbiological confirmation. Screen for TB symptoms and TB exposure in all children at every healthcare encounter Identify high-... | ACCEPT | train |
2fed4add108541b2b6fd9ca70e7abbcb | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Clinical Management of Tuberculosis in Children | 1. Please see Tables 2 and 3 for additional details on the clinical features of TB.
2. Ensure HIV status has been established and managed appropriately.
3. If the patient is not severely ill and if the diagnosis or persistence (>2 weeks) of symptoms is uncertain, consider a follow-up evaluation in 1-2 weeks to reasse... | 1. Please see Table 2 and Table 3 for additional details on the clinical features of TB. 2. Ensure HIV status has been established and managed appropriately. 3. If not severely ill, and if diagnosis or persistence (> 2 weeks) of symptoms are uncertain, consider a follow-up evaluation in 1-2 weeks to reassess weight and... | ACCEPT | train |
6beb50f7acf441d38612a7682c8b6d48 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Timely TB Treatment in High-Risk Children | A decision to start TB treatment should not be delayed if the necessary investigations are not available, particularly in children at higher risk of developing severe disease, such as young children, malnourished children, or those living with HIV. | A decision to start TB treatment should not be delayed if the necessary investigations are not available, particularly in children at higher risk of developing severe disease, such as young children, malnourished children or those living with HIV. | ACCEPT | train |
059539e5f19849f1b95faa788363c2b2 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | TB Treatment Decision Algorithm | Immunizations as per RTHB. Identifying TB source patients and TB infection control. HIV testing and ART for CALHIV. Assess post-TB health. Education and psychosocial support. Clinicians should provide TB management as part of an integrated package of care during clinical consultation visits. Failure to combine care lea... | immunisations as per RTHB Identifying TB source patients & TB infection control HIV testing and ART for CALHIV Assess post-TB health Education and psychosocial support Clinicians should provide TB management as part of an integrated package of care at clinical consultation visits. Failure to combine care leads to incre... | ACCEPT | train |
87a7495d1a3245f5930de4a3754b254d | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Diagnosis Determine starting regimen and treatment duration | As illustrated in Figure 8 on page 31, the regimen prescribed for DS-TB should consider the following:
- Whether treatment initiation is urgent, such as in the case of TBM.
- Whether TB disease is categorized as severe or non-severe based on clinical presentation and CXR abnormalities.
- What treatment regimen is i... | As illustrated in Figure 8 on page 31, the regimen prescribed for DS-TB should consider the following: • whether treatment initiation is urgent, such as in the case of TBM. • whether TB disease is categorised as severe or non-severe on the basis of clinical presentation and CXR abnormalities. • what treatment regimen i... | ACCEPT | train |
afce626fd9d449679fe1b823c64ccac0 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Initiating TB Treatment | - The site of TB (neurological vs. non-neurological sites).
- The duration the treatment regimen is prescribed, determined by:
- An assessment of disease severity at the start of treatment to determine eligibility for the new shortened 4-month treatment regimen.
- The site of TB; for example, TB of the bone/joints ... | • the site of TB (neurological vs non-neurological sites) • the duration the treatment regimen is prescribed, determined by: • an assessment of disease severity at the start of treatment to determine eligibility for the new shortened 4-month treatment regimen. • the site of TB, e.g. TB of the bone/joints require longer... | ACCEPT | train |
9ab5024457934b02bc256dcaab18958e | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Diagnosis Determine starting regimen and treatment duration | Decision to treat for DS TB follows an evaluation for TB and the most likely drug susceptibility profile (see TB Diagnostic Algorithm in Section 6).
8.1 Assessing TB Disease Severity:
- TB disease in children and adolescents ranges from non-severe to severe.
- Children with non-severe pulmonary DS-TB and DS cervical ... | Decision to treat for DS TB following an evaluation for TB and the most likely drug susceptibility profile (See TB Diagnostic Algorithm in Section 6. 8.1 Assessing TB disease severity • TB disease in children and adolescents ranges from non-severe to severe. • Children with non-severe, pulmonary DS-TB and DS cervical T... | ACCEPT | train |
dae770bd3d624e1ca043864f58f78c39 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Initiating TB Treatment | The following clinical factors must be considered to determine the severity of TB disease:
- Age of the child:
- Very young children have a high risk of disseminated disease; therefore, children <3 months of age are not eligible for treatment shortening.
- Older children (above approximately eight years of age) ar... | The following clinical factors must be considered to determine the severity of TB disease. foot_0 Age of the child • Very young children have a high risk of disseminated disease; therefore, children <3 months of age are not eligible for treatment shortening. • Because older children (above approximately eight years of ... | ACCEPT | train |
8245a62e6a254b68973da15b5b23b960 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Characteristics of the TB episode | • Children presenting with danger signs indicating severe illness (see Box 1 on page 8) are not eligible for treatment shortening. • Children with severe acute malnutrition are not eligible for treatment shortening, as this indicates a more severe or complex disease. | • Children presenting with danger signs indicating severe illness (see Box 1 on page 8) are not eligible for treatment shortening. • Children with severe acute malnutrition are not eligible for treatment shortening as this indicates more severe/complex disease. | ACCEPT | train |
a173202e7f13456ca40eea6a6119115b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Clinical and Nutritional status | • Children presenting with danger signs indicating severe illness (see Box 1 on page 8) are not eligible for treatment shortening. • Children with severe acute malnutrition are not eligible for treatment shortening, as this indicates a more severe or complex disease. | • Children presenting with danger signs indicating severe illness (see Box 1 on page 8) are not eligible for treatment shortening. • Children with severe acute malnutrition are not eligible for treatment shortening as this indicates more severe/complex disease. | ACCEPT | train |
9cde95b5edb44cd59bb4e3db2970a7c5 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Radiological TB disease severity | - The CXR is an important tool for assessing pulmonary disease severity and identifying possible disseminated disease in children and adolescents.
- It should be obtained if at all possible. If a CXR at initial diagnosis is unavailable, an image taken within the first month of therapy can be used to assess the severit... | • The CXR is an important tool for assessing pulmonary disease severity and identifying possible disseminated disease in children and adolescents. • It should be obtained if at all possible. If a CXR at initial diagnosis is unavailable, an image taken within the first month of therapy can be used to assess the severity... | ACCEPT | train |
f804e5fe938545e3916fa90c6c1036ff | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Note: Alveolar opacification is also referred to as "consolidation." A detailed approach to CXR interpretation in child and adolescent TB is outlined in the Union's Diagnostic CXR Atlas for Tuberculosis in Children. https://theunion.org/technical-publications/diagnostic-cxr-atlas-for-tuberculosis-in-children | Note: alveolar opacification is also referred to as "consolidation" A detailed approach to CXR interpretation in child and adolescent TB is outlined in the Union's Diagnostic CXR Atlas for Tuberculosis in Children. https://theunion.org/technical-publications/diagnostic-cxr-atlas-for-tuberculosis- in-children | ACCEPT | train |
f38f540392d74dd0a2a22a1c1185da5b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | • Healthcare workers should always attempt to obtain bacteriological confirmation of TB in patients.
• A positive TB NAAT (e.g., Xpert MTB/RIF or Xpert MTB/RIF Ultra) and/or culture-positive TB result in isolation does not indicate severe disease. Other clinical and radiological features of disease severity must be a... | • Healthcare workers should always attempt to obtain bacteriological confirmation of TB in patients. • A positive TB NAAT (e.g., Xpert MTB/RIF or Xpert MTB/RIF Ultra) and/or culture-positive TB result in isolation does not indicate severe disease. Other clinical and radiological features of disease severity must be ass... | ACCEPT | train |
4505d3c9ed104c6f841b264ba4718292 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | If not eligible for the shortened treatment regimen, treat for the standard duration (Table 8). Routine smears for AFB are not recommended as part of the diagnostic work-up. However, if there is an AFB smear positive result on any respiratory sample, the child is not eligible for treatment shortening. FNA smear positiv... | If not eligible for the shortened treatment regimen, treat for standard duration (Table 8 ) Routine smears for AFB are not recommended as part of the diagnostic work-up. However, if there is an AFB smear positive result on any respiratory sample, the child is not eligible for treatment shortening. FNA smear positivity ... | ACCEPT | train |
4990162bfafa488c947eab46cbbf7935 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | If cervical peripheral lymph nodes did not decrease in size at month 4, continue treatment for 6 months. If there is no significant reduction in the size of the lymph nodes, or if there is enlargement or complications—especially if TB was not bacteriologically confirmed—refer for further investigation (biopsy or aspira... | If cervical peripheral lymph nodes did not decrease in size at month 4, continue to 6 months of treatment. If there was not a significant reduction in size of the lymph nodes, enlargement or complications, especially if TB was not bacteriologically confirmed, refer for further investigation (biopsy or aspiration) to ex... | ACCEPT | train |
1beca748514e4618a397eb84c86b326d | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | If not eligible for the shortened treatment regimen, treat for the standard duration (Table 8). Routine smears for AFB are not recommended as part of the diagnostic work-up. However, if there is an AFB smear-positive result on any respiratory sample, the child is not eligible for treatment shortening. FNA smear positiv... | If not eligible for the shortened treatment regimen, treat for standard duration (Table 8 ) Routine smears for AFB are not recommended as part of the diagnostic work-up. However, if there is an AFB smear positive result on any respiratory sample, the child is not eligible for treatment shortening. FNA smear positivity ... | ACCEPT | train |
6223b93c39974af9b40ecf06f7bb6ced | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Identifying adult TB source patients and implementing infection control | - Children with TB usually contract the disease from an infectious adult with TB.
- Therefore, it is important to find the source of infection and any other child contacts, where appropriate, to prevent further TB transmission.
- When a child is diagnosed with any form of TB, the parents and other household members (... | • Children with TB usually contract the disease from an infectious adult with TB. • Therefore, it is important to find the source of infection and any other child contacts, where appropriate, to prevent further TB transmission. • When a child is diagnosed with any form of TB, the parents and other household members (if... | ACCEPT | train |
a9f993bb6c284493af2594c37732de74 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Box 4 Measures to prevent TB transmission in the home | - Instruct patients to cover their mouth and nose with their sleeve or a tissue when coughing or sneezing. Afterward, they should wash their hands and dispose of the tissue in the bin.
- Windows and doors must be kept open (weather permitting) to increase ventilation and dilute infectious particles in the house.
- Wh... | • Instruct patients to cover their mouth and nose with their sleeve or a tissue when coughing or sneezing. After that, they should wash their hands and throw their tissue in the bin. • Windows and doors must be kept open (weather permitting) to increase the ventilation and dilution of infectious particles in the house.... | ACCEPT | train |
bb5e68abdbc64e12a4232e659e40cc04 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Providing other routine care and nutritional support as per the RTHB | • Energy needs increase in children with TB by 20-30%, depending on age and growth status at assessment. It is important to advise the caregiver on how to meet the additional energy needs using food available at home. If this is not possible, nutritional supplements should be provided.
• Children with severe malnutri... | • Energy needs increase in children with TB by 20 -30%, depending on the age and growth status at assessment. It is important to advise the caregiver on how to meet the additional energy needs using food available at home. Where this is not possible, nutritional supplements should be provided. • Children with severe ma... | ACCEPT | train |
9714a68b90e74f03b3bf6e274db61670 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | The link between TB and malnutrition | TB and malnutrition are closely linked because malnutrition reduces cell-mediated immunity, increasing the risk of TB disease after infection. Additionally, the catabolic effect of TB disease results in weight loss and wasting, worsening malnutrition. | • TB and malnutrition are closely linked because: • malnutrition results in the reduction of cell-mediated immunity, thereby increasing the risk of TB disease after infection, and • the catabolic effect of the TB disease results in weight loss and wasting, worsening the malnutrition. | ACCEPT | train |
c3e71c2c962f4d8b9c6ff39b876561e8 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Providing patient education and psychosocial support | TB is still associated with stigma and loss of income. Therefore, every child, adolescent, and family being treated for TB should receive information, education, and emotional support to alleviate fear and anxiety. The clinician should communicate in a way that enhances the healthcare worker-patient relationship and im... | TB is still associated with stigma and loss of income. Therefore, every child, adolescent and family being treated for TB should receive information, education, and emotional support to alleviate fear and anxiety. The clinician should communicate in a way that enhances the healthcare worker-patient relationship and imp... | ACCEPT | train |
b754785c2423495baa3774db92a64a68 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Treatment of pulmonary and extrapulmonary DS-TB | The treatment principles of drug-susceptible tuberculosis (DS-TB) in children are similar to those used in adults. Treatment consists of two phases:
1. An intensive phase of 2 months consisting of 4 drugs:
- Isoniazid
- Rifampicin
- Pyrazinamide
- A fourth drug: either ethambutol (used in most cases) or et... | The treatment principles of DS-TB in children are similar to those used in adults. Treatment consists of 2 phases: • An intensive phase of 2 months consisting of 4 drugs: • isoniazid, rifampicin and pyrazinamide, and • a fourth drug: either ethambutol in most, or ethionamide • ethambutol will be used in most children, ... | ACCEPT | train |
96fbae7499c146c583ad610314bc488e | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Treatment of pulmonary and extrapulmonary DS-TB | All children and adolescents with DS-TB (excluding TBM, other forms of CNS TB, and miliary TB) will initiate the same intensive phase of TB treatment using four anti-TB medications. However, the duration of the continuation phase depends on eligibility for treatment shortening, the site of TB, and the response to thera... | All children and adolescents with DS-TB (excluding TBM, other forms of CNS TB and miliary TB) will initiate the same intensive phase of TB treatment using four anti-TB medications. However, the duration of the continuation phase depends on the eligibility for treatment shortening, the site of TB and the response to the... | ACCEPT | train |
f1cdcddf711c48f6a3a8a99d2cdbd8c1 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Obtain expert advice.
Dosage recommendations:
- For weight band 2 - 2.9 kg: ½ tablet (1 ml)
- For weight band 3 - 3.9 kg: ¾ tablet (3 ml)
- For weight band 4 - 7.9 kg: 1 tablet (2.5 ml)
- For weight band 8 - 11.9 kg: 2 tablets (4 ml)
- For weight band 12 - 15.9 kg: 3 tablets (6 ml)
- For weight band 16 - 24.9 kg: 4 t... | Obtain expert advice <2 2 -2.9 ½ tab 1 ml ½ tab 2 -2.9 3 -3.9 ¾ tab (3 ml) ♦ 1.5 ml ¾ tab (3 ml) ♦ 3 -3.9 4 -7.9 1 tab 2.5 ml 1 tab 4 -7.9 8 -11.9 2 tabs ½ tab or 4 ml 2 tabs 8 -11.9 12 -15.9 3 tabs ¾ tab or 6 ml 3 tabs 12 -15.9 16 -24.9 4 tabs 1 tab or 8 ml 4 tabs 16 -24.9 25 HRZE 75/150/400/275 mg tablet Choose one o... | ACCEPT | train |
9218a36393a24baa9f59ce2309c3e08f | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | The use of corticosteroids in children with TB | The evidence for the use of corticosteroids in children with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) is limited. Oral corticosteroids should be considered in children with the following forms of TB:
- Intra-thoracic lymphadenopathy with significant airway compression
- TB immune reconstit... | The evidence for the use of corticosteroids in children with PTB and EPTB is limited. Oral corticosteroids should be considered in children with the following forms of TB: • Intra-thoracic lymphadenopathy with significant airway compression. • TB immune reconstitution inflammatory syndrome (IRIS). • TBM (refer to Secti... | ACCEPT | train |
86e485b3daed4a6681ff2793276f26e2 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Children and adolescents without HIV | The duration of therapy is six months, and all four drugs should be used for the full six months. In children with complex disease, where treatment interruptions or changes occurred, or in children with significant immune dysfunction, the treatment duration can be extended to nine months or longer. If there is uncertai... | • The duration of therapy is six months, and all four drugs should be used for the full six months. • In children with complex disease, where treatment interruptions or changes occurred, or in children with other significant immune dysfunction, the treatment duration can be extended to 9 months or longer. If there is u... | ACCEPT | train |
b5269eed558447bc900cb179853f7d50 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Children and adolescents living with HIV | • Children living with HIV who are not on antiretroviral therapy (ART) should delay the initiation of ART for at least four weeks to reduce the risk of TB-IRIS.
• Children living with HIV who are already on ART require:
- Review of adherence to ART and identification of virological failure.
- HIV viral load shoul... | • Children living with HIV not on antiretroviral therapy (ART) should delay initiation of ART for at least four weeks to reduce the risk of TB-IRIS. • Children living with HIV and already on ART require: • Review of adherence to ART and identification of virological failure • HIV viral load should be performed if on tr... | ACCEPT | train |
95f659721f9c406f835dd3d5bef5995b | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Obtain expert advice. For weight band 2-2.9 kg, for each dose, disperse 1 x HR 50/75 mg tablet in 4 ml of water, administer 3 ml, and discard unused suspension. For other weight bands, an oral suspension can be made by dispersing the required number of tablets and fractions of tablets in a small amount of water (5-10 m... | Obtain expert advice <2 2 -2.9 ≥50 4 tabs 4 tabs or 32 ml ≥50 Children should be taught and encouraged to swallow whole tablets or, if required, fractions of tablets so as to avoid large volumes of liquid medication if possible ♦ To make an oral suspension for weight band 2 -2.9 kg, for each dose, disperse 1 x HR 50/75... | REJECT | train |
e5c5fce019ef470d958570b3646a834e | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Prevention of stroke and anti-inflammatory therapy | • All children with presumed TBM should initially be hospitalized. Twenty-five percent of children who present without a stroke will develop infarctions in the first month of treatment.
• All children should receive oral prednisone at a dose of 2 mg/kg/day (maximum dose 60 mg) for one month, followed by a 2-week wean... | • All children with presumed TBM should initially be hospitalised. Twenty-five per cent of children who present without a stroke will develop infarctions in the first month of treatment. • All children should receive oral prednisone 2 mg/kg/day (maximum dose 60 mg) for one month, followed by a 2-week weaning period. If... | ACCEPT | train |
db6157e209b84677bc28695f62e5a75f | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Hydration status should be monitored carefully, and consider repeating the assessment after 24 hours if the patient remains clinically stable. | hydration status carefully and consider repeating after 24 hours if it remains clinically stable. | ACCEPT | train |
b8daf3d63fd347f280929db28e5c00b2 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Intravenous correction is usually needed: correction at 4 mmol/L over 24 hours. If neurological symptoms associated with low sodium occur, an initial bolus of 3 mL/kg over 1 hour of 3% saline can be considered. If chronic hyponatraemia occurs, oral correction can be considered, provided there are no symptoms of hyponat... | Intravenous correction is usually needed: correction at 4 mmol/L over 24 hours. If neurological symptoms associated with low sodium occur, an initial bolus of 3 mL/ kg over 1 hour of 3% saline can be considered. If chronic hyponatraemia occurs, oral correction* can be considered, provided there are no symptoms of hypon... | ACCEPT | train |
88e1f57d04cf457995f1639475d9f538 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | x | Intravenous correction is usually needed: correction at 4 mmol/L over 24 hours with a maximum correction of 8 mmol/L for 24 hours. Regardless of neurological symptoms, an initial bolus of 3-5 mL/kg of 3% saline over 1 hour can be considered.
- Sodium deficit: Weight in kg x 0.6 x (140 - current serum sodium).
- If 0... | Intravenous correction is usually needed: correction at 4 mmol/L over 24 hours with a maximum correction of 8 mmol/L for 24 hours. Regardless of neurological symptoms, an initial bolus of 3-5 mL/kg of 3% saline over 1 hour can be considered. • Sodium deficit: Weight in kg x 0.6 x (140 -current serum sodium) • If 0.9% N... | ACCEPT | train |
6f0f83305bfe46ff93ec16098bf11fa7 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Criteria for discharge of CNS TB/TBM patients | The following criteria should be reviewed when considering discharge to home while on anti-tuberculosis therapy:
- Good tolerance of treatment.
- Caregivers with good insight and demonstrated ability to administer and adhere to treatment.
- Social circumstances conducive to strict medication adherence, appointments, a... | The following criteria should be reviewed when considering discharge to home whilst on anti-tuberculosis therapy: • Good tolerance of treatment. • Caregivers who have good insight and demonstrated ability to administer and adhere to treatment. • Social circumstances conducive to strict medication adherence, appointment... | ACCEPT | train |
4eff34ec54bb439a8c4d45db306d3ee0 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Other forms of central nervous system TB 10.5.1 Tuberculoma | Anti-tuberculosis therapy is the same as for TBM. There are no data to guide the use of corticosteroids in the management of children with a normal lumbar puncture and no neurological features. However, because the involvement of the brain and meninges cannot be excluded through lumbar puncture and/or imaging, and beca... | Anti-tuberculosis therapy is the same as for TBM. There are no data to guide the use of corticosteroids in the management of children with normal lumbar puncture and no neurological features; however, because the involvement of the brain and meninges cannot be excluded through lumbar puncture and/or imaging, and becaus... | ACCEPT | train |
3008f82ca0ad46adaa9d2b7e1856adc4 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Spinal arachnoiditis | Tuberculous arachnoiditis can develop in the spinal cord in the absence of bone disease through the breakdown of granulomatous foci in the cord or meninges. If identified on an MRI, it should be managed as TB meningitis (TBM). If there is uncertainty, it should be discussed with an expert or referred for assessment. | Tuberculous arachnoiditis can develop in the spinal cord in the absence of bone disease through the breakdown of granulomatous foci in the cord or meninges. If this is identified on an MRI, it should be managed as TBM. If there is uncertainty, it should be discussed with an expert or referred for assessment. | ACCEPT | train |
cc1b3c82516b40e7b3eea494c9cc8ff7 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Miliary tuberculosis | Treatment should not be delayed while waiting for results; the anti-tuberculosis drug regimen is the same as for TBM. There are no data to guide the use of corticosteroids in the management of children with a normal LP and no neurological features. However, because the involvement of the brain and meninges cannot be ex... | Treatment should not be delayed while waiting for results; the anti-tuberculosis drug regimen is the same as for TBM. There are no data to guide the use of corticosteroids in the management of children with a normal LP and no neurological features; however, because the involvement of the brain and meninges cannot be ex... | ACCEPT | train |
4ec6faabbd1b491783abf222f4f071cc | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Perinatal Tuberculosis in Infants | Perinatal TB in infants < 3 months of age can be either congenital or postnatal in origin. Congenital TB is transmitted in utero through: 1) transplacental spread via the umbilical vein to the fetal liver, or 2) aspiration or ingestion of infected amniotic fluid (in utero/intrapartum). Postnatal TB occurs through the i... | Perinatal TB in infants < 3 months of age can be either congenital or postnatal in origin. • Congenital TB is transmitted in utero through 1) transplacental spread through the umbilical vein to the fetal liver (in utero) or through 2) aspiration or ingestion of infected amniotic fluid (in utero/ intrapartum) • Postnata... | ACCEPT | train |
96ca2687011c4f8595debd7e6e422368 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Epidemiology | - Due to pregnancy-related immunological changes, women are at higher risk of developing TB disease during pregnancy and the immediate postpartum period.
- HIV infection further increases this risk, and the TB prevalence in pregnancy among HIV-positive women can be as high as 11% in high HIV-burden countries.
- TB in... | • Due to pregnancy-related immunological changes, women are at higher risk of developing TB disease during pregnancy and the immediate postpartum period. • HIV infection further increases this risk, and the TB prevalence in pregnancy in HIV-positive women can be as high as 11% in high HIV-burden countries foot_2 • TB i... | ACCEPT | train |
bc258e75b19445ce98fdcb0a3b03dfd4 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Newborn Exposure to Tuberculosis | A newborn has had significant exposure to an infectious TB source patient if:
- The baby was born to a mother with TB and the mother:
- was started on treatment for TB ≤ 2 months before delivery, or
- is demonstrating poor clinical response to TB treatment, or
- is TB smear or TB culture positive at delivery, or... | A newborn has had significant exposure to an infectious TB source patient if: • The baby was born to a mother with TB and the mother: • was started on treatment for TB ≤ 2 months before delivery or • is demonstrating poor clinical response to TB treatment or • is TB smear or TB culture positive at delivery or • was dia... | ACCEPT | train |
84f8c542d17d4841bc72613da69fb197 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Algorithm for the management of the TB exposed newborn | Here is the cleaned medical text:
Support adherence, evaluate for side effects, monitor weight, and adjust doses. Evaluate for TB symptoms until TPT is completed. Ensure that HIV testing and prophylaxis (or ART treatment) has been provided as appropriate.
For HIV-exposed/HIV-positive infants, avoid using NVP, DTG, L... | or drug susceptibility unknown Support adherence, evaluate for side-effects, monitor weight and adjust doses, evaluate for TB symptoms until TPT completed. Ensure that HIV testing and prophylaxis (or ART treatment) has been provided as appropriate NO HIV-exposed/HIV-positive baby on NVP, DTG or LPV/r or on any other dr... | ACCEPT | train |
4ee77b1f59f14928a1053ce0aeafb2c5 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Considerations for antiretroviral treatment 19 | The timing of ART initiation: In children newly diagnosed with HIV or those who have disengaged from HIV care, ART should be started as soon as TB treatment is tolerated—ideally within two weeks after starting TB treatment. However, in cases of TBM/CNS TB, ART should be initiated after one month of TB treatment (refer ... | The timing of ART initiation • In children newly diagnosed with HIV or children that disengaged from HIV care, ART should be started as soon as TB treatment is tolerated -ideally within two weeks after starting TB treatment unless there is TBM/CNS TB, in which case ART should be started after one month of TB treatment ... | ACCEPT | train |
0094d2f749e645479577a32d16b10059 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Patient-centred care | Once TB is diagnosed, appropriate treatment can be initiated, and the episode can be managed as outlined in Sections 8 onwards. However, the effectiveness of clinical management improves significantly when we also consider the "How," the "Who," and the "Where" these services should be delivered. A patient-centered appr... | Once TB is diagnosed, appropriate treatment can be initiated, and the episode can be managed as outlined in Sections 8 onwards. However, the "What" of clinical management will be that much more effective if we also consider the "How," the "Who," and the "Where" these services should be delivered. A patient-centred appr... | ACCEPT | train |
fbf094a91b8c4544955052bffbf01694 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Integrated Care for TB Management in Mother-Child Pairs | A practical approach is as follows:
- Wherever possible, align the visit schedule for TB management and any other care the child may need with the EPI visit schedule.
- Aim to provide all care for the child at the same service point or at least on the same return date and at the same facility.
- Wherever possible, ... | A practical approach is as follows: • Wherever possible, align the visit schedule for TB management and any other care the child may need with the EPI visit schedule. • Aim to provide all care for the child at the same service point or at least on the same return date and at the same facility. • Wherever possible, try ... | ACCEPT | train |
8dfa2b6c76734259a33933ee37ca4450 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Clinical monitoring | - Most children will respond well to TB treatment.
- Children responding well to treatment will experience a resolution of symptoms and gain weight.
- Children should be monitored at least monthly for the first two months and every two months until treatment is completed.
- The child/adolescent should be assessed at... | • Most children will respond well to TB treatment. • Children responding well to treatment will have a resolution of symptoms and will gain weight. • Children should be monitored at least monthly for the first two months and every two months until treatment is completed. • The child/adolescent should be assessed at eac... | ACCEPT | train |
498f15a1f63f44d39b2d9d248015d5ed | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Assessing treatment response after four months on the shortened treatment regimen | • The response to treatment will determine if the child is eligible to end the new shortened treatment regimen after four months.
• The final decision on treatment duration should be made during the follow-up visit at the end of month four.
**Determine the Clinical Response to TB Treatment:**
1. Assess the bacteriol... | • The response to treatment will determine if the child is eligible to end the new shortened treatment regimen after four months of treatment. • The final decision on treatment duration should be made during the follow-up visit at the end of month four. Determine the Clnical response to TB treatment 1 Determine the Bac... | ACCEPT | train |
14de580cc09341ad93615ea407418470 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | The role of CXRs during TB management | - The CXR is a poor indicator of treatment response, as the intra-thoracic lymph nodes can initially enlarge due to improvement in the child's immunity or due to ART in CLHIV. Therefore, follow-up CXRs are not routinely recommended in children with non-severe TB or asymptomatic children during or at the end of TB treat... | • The CXR is a poor indicator of treatment response, as the intra-thoracic lymph nodes can initially enlarge because of the improvement in the child's immunity or due to ART in CLHIV. Therefore, follow-up CXRs are not routinely recommended in children with non-severe TB or asymptomatic children during or at the end of ... | ACCEPT | train |
be61ec66f87a423aa3b52fb2f0e364e4 | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Bacteriological monitoring | - Confirming the result of the initial culture specimen at follow-up visits is very important.
- Bacteriological monitoring in children with a good clinical response is rarely implemented due to difficulties around sample collection.
- If a child was smear or culture positive at TB diagnosis, treatment response can b... | • Confirming the result of the initial culture specimen at follow-up visits is very important. • Bacteriological monitoring in children with a good clinical response is rarely implemented due to difficulties around sample collection. • If, however, a child was smear or culture positive at TB diagnosis, treatment respon... | ACCEPT | train |
12cab44ffa1a42b39a75ee225e64323a | MANAGEMENT OF TB IN CHILDREN AND ADOLESCENTS.pdf | Management of adverse drug events | Inadequate management of side effects and adverse events is the main reason patients discontinue medications and, therefore, one of the primary reasons for treatment failure. Adverse events caused by TB medications are less common in children than in adults. The most important adverse event associated with first-line m... | Inadequate management of side effects and adverse events is the main reason patients discontinue medications and, therefore, one of the primary reasons for treatment failure. • Adverse events caused by TB medications are less common in children than in adults. • The most important adverse event on first-line medication... | ACCEPT | train |
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