PediatricTuberculosis

TBBurdeninIndia

HighestTBburdencountry(1/5th ofglobal)

17th among22highburdencountriesinterms
ofTBincidence.
WHOReport2009
 PediatricTB:Characteristics
Infectionoccursforfirsttime
Wellmarkedenlargementofregionallymphatic
nodes
Tuberclebacillispreadbylymphatic&
hematogenous route
CavityinprimaryTBisthinwalled
Primaryinfectionususlly noninfectious
Mortalitymainlyduetoextrapulmonary TB
Healingbymainlycalcification
 AdultTB:Characteristics
Tissuesalreadyexposed.
Loweringofimmunedefences locallyinlungs,
leadstoreactivation&mainlylocallyprogressive
disease.
NosignificantregionalorhilarLAP.
Localizedtooneorgan.
Hematogenous spreaduncommon.
Maincauseofdeath.
Healingoflesionsbyfibrosis.
 Pathogenesis
PrimaryTB:
NegativeMx toPositiveMx
Airborneusually
Incubationperiod:48weeks
Primaryfocus:Apexofupperorlowerlobe
Primaryfocusinthelung,lymphangitis &
enlargedhilarLNknownasPrimaryComplex
ofRanke
 Pathogenesiscont
Intracellularinfection

Spreadsvialymphatics &bloodstream

Delayedtypeimmunologicalreactivity

ControlledbyTlymphocytes.
 HostimmuneresponsetoTB
CMI: Tubercle
Bacilli

Tubercle Macrophage
Bacilli (APC)

TCell

Cytokines

GRANULOMA
 HostimmuneresponsetoTBcont
DTH:
DuetoTsuppressorcells

Specificornonspecific

Leadstodestructionofhosttissues&may
containbacteria.
Tuberculosiswithouttubercles
 ResponsetoTBinfection
1.Onlyinfection&nodisease.

2.Primarycomplexdevelopment.

3.Progressivedisease

4.Granulomatous necrotizingordestructive
cavitary TB.

5.Pneumonicformwithnocavity
TBSpectrum
 Parenchymal Progression
PC
HPC
Pneumonia
Massivepneumonia
Primarycavity
Bronchopneumonia
Pleurisy
 ComplicatedLNTB
Mediastinal LNenlargement

Partialbronchialobstruction

Completebronchialobstruction

Ruptureofsubcarinal LN
 Hematogenous spread
Miliary TB

CNSTB

DisseminatedTB

Dactylitis

Isolatedbone&jointinvolvement
 ChronicPulmonaryTuberculosis
Assmanns focus

Pulmonaryinfiltration

CPT:Cavitary
Fibrous
Fibrocaseous
ImpactofBCGVaccination

Intrathoracic versusExtrathoracic
 RNTCP
BasedoninternationallyrecommendedDOTS

Launchedin1997

Expandedinphasedmanner

SupportfromWorldBank
 ObjectivesofRNTCP
Toachieve&maintaincurerateofatleast
85%amongnewsputumpositive(NSP)
patients

Toachieve&maintaincasedetectionofat
least70%ofestimatedNSPcasesinthe
community.
 RNTCPcont
PWBstartedsince2006