Tuberculosis
A chronic, infectious disease primarily attacking the lungs.
Tuberculosis (TB) is an chronic, infectious disease caused by Mycobacterium tuberculosis that primarily attacks the lungs. The tubercle bacillus is transmitted by droplets when an infected person coughs or sneezes. It is not spread through kissing or other physical contact. Children nearly always contract the disease from an infected adult.
The TB-infected areas of the lungs become dry and cheese-like, eventually hardening into scar tissue. The severity of the attack depends on whether the bacteria spreads from the lungs to other parts of the body. Tuberculin infection in the blood, the meninges (membranes around the brain and spinal cord), or the kidneys are the most serious. Children between the ages of six and 24 months are the most susceptible to meningitis; it is the chief cause of tuberculin death among children.
In 1987, there were one to two cases of tuberculosis for every 10,000 people in the United States. By 1993, the Centers for Disease Control's Division of Tuberculosis Elimination was reporting significant increases in the incidence of TB among children under 15. The AIDS epidemic and antibiotic-resistant strains of TB have also contributed to the rise in the number of TB cases. The highest incidence occur on the East Coast, the Southeast, and the Southwest.
Early symptoms include unusual fatigue, loss of weight, headache, coughing, and irritability. The childmay have night sweats and cough up blood. In advanced stages, the patient will suffer persistent coughing, breathlessness, and fever. Many times TB is not diagnosed and becomes dormant; this is known as initial tuberculosis. In severe cases among young children between the ages of two and four, initial TB can be fatal. The disease can reoccur, or reactivate, during adolescence when resistance is low, and may disappear on its own or develop into serious lung disease.
Tuberculosis is nearly always diagnosed by tuberculin skin tests, although one can also be diagnosed by chest χ rays and analysis of sputum smears and cultures. The most common tuberculin skin test is the Mantoux test, which consists of injecting a small amount of protein from the tubercle bacillus into the forearm. A reddening and swelling of the area after 24-72 hours signals the presence of TB. However, a negative result may not necessarily exclude a diagnosis of TB.
The disease is treated with a regimen of strong antibiotics such as Refampin and Isoniazid for six months to two years. Because some strains of the disease are unusually drug-resistant, cultures are grown from the patient's bacteria and tested with a variety of drugs to determine the most effective treatment. In cases of strong drug-resistant strains, the child may undergo surgery to remove the infected areas. The recent appearance of multi-drug-resistant tuberculosis (MDR TB) is prompting the CDC to reexamine the benefits of a vaccination against TB.
Infants with TB are usually hospitalized but children and teenagers can generally lead active lives within two weeks of beginning medication. It is imperative that the mediation prescribed be taken faithfully.
Stopping the spread of tuberculosis is the most effective way of preventing its incidence among children. All adults who work with children should be screened regularly. In most communities, children are tested when they reach their first birthday and then at one-to-three year intervals throughout the school years. The medical profession is divided on the issue of screening; some physicians believe that the screening should be focused in areas of common occurrence or within high-risk populations such as foreign-born children. The practice of relying on parents to report results of the skin testing has also come under criticism from some members of the medical community.
For Further Study
Books
Landau, Elaine. Tuberculosis. New York: F. Watts, 1995.
Tuberculosis. Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, 1981.
Organizations
American Lung Association
Address: 1740 Broadway
New York, NY 10019
Telephone: (212) 315-8700
The National Medical and Research Center, Global Leader in Lung, Allergic and Immune Diseases
Address: 1400 Jackson Street
Denver, Colorado 80206
Telephone: (303) 398-1079
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