Tuberculosis

Introduction

Though common in child from poorer homes. I have seen quite a few children with tuberculosis from a  higher socio-economic group. Fortunately we now have excellent drugs available for the treatment and , if diagnosed early, the prognosis in most cases is excellent.

The following are the symptoms that should alert us to the  possibility of the child having tuberculosis.. But don't jump to conclusions because similar symptoms can also be found in many other conditions.

• Persistent unexplained fever, cough, loss of weight and appetite.
• Enlarged glands in the neck or armpits or groin, which seems to get struck to each other (not discrete and separate from each other) . They may also struck to the overlying skin.
• Pain in the chest with pleurisy (infection of the pleura covering the lungs). Unexplained swelling of a bone or joint and backache.
• Persistent pain in abdomen with diarrhea or swelling in the abdomen.
• Persistent headache and vomiting, convulsions or disturbed consciousness.
• Unresolved pneumonia or glands noticed in X-ray of the chest.
• Contact with an adult having tuberculosis.

Tiny little palpable glands in the neck or elsewhere should not be confused with tuberculosis. They are often secondary to some local infection rather than tuberculosis, or due to a disease like chickenpox or lice in the head.

Pain in the abdomen is mostly due to cause other than tuberculosis.

Confirmatory diagnosed can only be made by demonstrating the presence of TB germs. This is not always possible.

A Mantoux Test (Tuberculin test) is asked for. It should not be Done with 10 TU OR 100 TU, that may give false result. The test should be done with 5 TU, some recommend it with 1 TU.

A positive test does not necessarily mean that the child needs treatment for tuberculosis. We have to examine the patient in totality,  including the presence or absence of B.C.G scar, the symptoms, general condition, history of contact and results in other test including the X- Ray of the chest, examination of the pleural fluid effusion (collection of fluid between the covering of the lungs). Biopsy of the gland or bone. Examination of cerebrospinal fluid (C.S.F) in case of suspected meningitis etc.

The C.S.F is taken out by tapping the space between the two lower spinal vertebra with a lumber puncture needle.

In absence of other features, a child with a positive Mantoux test for 10 mm or more in the presence of a B.C.G scar is weighted on the same scale every month.. If it remains fit and continues to gain weight, no treatment is given.

Most cases of tuberculosis are treated with at least 3 anti-tubercular drugs to begin with.  One is given for 2 months and the other 2 for 6 months or more. One of these two are given on empty stomach.  Do not be surprised if it makes the child's urine appear red, this is normal.

As these drugs can cause liver damage  in a small number of patients  your doctor may keep an eye on your child's liver function test as and when required.

Some children may have mild liver dysfunction, but others can develop jaundice and severe liver damage In such cases the doctor will make significant changes in the treatment.

For parents, the most important aspect of treatment is to see that the treatment is not stopped prematurely.

After a month or two of treatment, children often look completely normal and some parents become lax about regular treatment. This can be hazardous.The organism can develop resistance to the drugs and they may not become as effective as before.

Management of contact with a case of tuberculosis

All the contact must be subjected to a tuberculin test. Your doctor will than decide whether a child needs further investigation or medication.

A newborn of a mother having active tuberculosis should be given B.C.G and kept apart from her as much as possible for about three months. The child has to kept under close supervision by the doctor. Breastfeeding should be continued. If the disease was diagnosed during pregnancy or soon after delivery your doctor may ask for tuberculin test and a chest X-ray to rule out a congenital infection being present from birth.

What food to eat  and avoid for better lung health ?

Do

Supplement your meal with these lung healthy ingredients

• Nutrient rich food like beet, greens, apple, pumpkin, turmeric and green tea to your diet can help protect the lungs.
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Don'ts

• Avoid consuming salty food
• Dairy products
• Processed meat
• Cold drinks
• Fried food 

All these can increase thr risk of lung disease.

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