Children and Adolescents

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.

Routine HIV testing should be offered to all children and adolescents completing evaluation for exposure to TB, with presumptive TB or diagnosed with TB. Early and accurate detection of HIV infection is important to support the integrated management of TB/HIV coinfection. All children and adolescents with HIV-associated TB are eligible for ART and co-trimoxazole prophylaxis (6, 78).

Testing for M. tuberculosis infection using TST or IGRA is useful to support a diagnosis of TB in children with suggestive clinical features who are sputum smear-negative or who cannot produce sputum. A positive test for TB infection indicates prior or current infection with M. tuberculosis and can be particularly useful in the absence of known TB exposure (no positive contact history), as it confirms the child has been infected at some point in time (6, 15).

TST is considered positive (indicating infection with M. tuberculosis) if:

The Xpert MTB/RIF assay is a cartridge-based automated test that uses real-time polymerase chain reaction (PCR) on the GeneXpert® platform to identify M. tuberculosis complex and mutations associated with rifampicin resistance directly from sputum specimens in less than 2 hours (76).

The Xpert MTB/RIF Ultra assay uses the same GeneXpert platform and a new enhanced cartridge developed to improve the sensitivity and reliability of detection of M. tuberculosis complex and rifampicin resistance (76).

Despite challenges with bacteriological confirmation of paucibacillary TB in young children, every effort should be made to establish bacteriological confirmation. In adolescents, who usually have adult-type disease, bacteriological confirmation is common.

Bacteriological confirmation is even more important for children and adolescents who:

The index patient is the initially identified person of any age with new or recurrent TB in a specific household or other comparable setting to which others may have been exposed. An index case is the person on whom a contact investigation is centred but is not necessarily the source case (28).

Young children have a higher risk of developing TB compared with other age groups (4). Risk of TB disease is more pronounced among children and adolescents who:

The management of babies born to women with TB is covered in Section 7.2. The main implications of TPT for the choice of ART in children and adolescents living with HIV are covered in Section 7.1.