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Chapter: Paediatrics: Infectious diseases

Paediatrics: Mycobacteria

Pulmonary tuberculosis due to Mycobacterium tuberculosis.



Pulmonary tuberculosis


Pulmonary tuberculosis due to Mycobacterium tuberculosis.


Atypical mycobacterial infection could be the cause of the following:


   Persistent lymphadenopathy: this infection is diagnosed after histology of a surgically resected node.


   Disseminated infection in the immunocompromised patient. Mycobacterium avium intracellulare: is an infection often seen in patients with advanced disease due to HIV.


Tuberculous meningitis (TBM)


TBM is the most feared complication of M. tuberculosis infection.

   Timing: usually occurs within 12mths of first infection.


   Age group: most frequently occurs in those <5yrs of age.


   Pathology: the initial pathology is occult haematogenous dissemination to the cerebral cortex from a p site (e.g. gut, lung). This increases in size until it reaches the meninges and subarachnoid space. A thick gelatinous exudate is created especially around the brainstem so that cranial nerves III, IV, and VI are commonly compromised. Hydrocephalus is common.


   Clinical course: the onset is insidious and is characterized by apathy or disinterest, then intermittent headaches and anorexia. Fever is almost always present. Vomiting occurs in 50%. Focal neurological signs, seizures, or severely depressed conscious level may occur.


   Diagnosis: 50% will grow Mycobacteria from their CSF and the Mantoux or gamma interferon release assay often positive. 40–90% have CXR changes of pulmonary disease.


   Prognosis: most survive if treated in the early insidious stage. There is a very high complication rate, especially if the focal neurological signs are present at the start of therapy.


Treatment: therapy with four antituberculous agents and corticosteroids is for at least 12mths and should be supervised by a specialist team.



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