Pediatric tuberculosis.

Pediatric tuberculosis (TB) is different than that in adults in several ways. (1) The diagnosis of TB is more difficult in children due to non-specific or complete absence of symptoms and difficulty in confirming the diagnosis microbiologically. (2) Young children suffer more extrapulmonary and disseminated TB than adults. (3) Treatment of TB in children is challenging due to the lack of pediatric drug formulations and challenges in monitoring for toxicity. Fortunately, children generally do very well with treatment and tolerate the medications well. Treatment regimens are very similar to those used in adults. Four drug treatment should be initiated for treatment of presumed active TB if there are any risks of drug resistance in the child or adult source case (including residence or travel to an area where there is > 4% resistance to INH). (4) Children should be TB skin tested only if they have risks for TB infection, are likely to progress to active TB, or are suspected of having active TB. Unlike adults, all children should be treated for latent TB infection if identified because the therapy is very safe in young people, they were likely to have been infected relatively recently, and they have a long time to reactivate their latent infection. (5) Young children are not contagious with active TB and acquired their disease from shared airspace with adolescents or adults with pulmonary TB or ingestion of unpasturized milk products (M. bovis).