Indian Pediatr. 2010 Jan;47(1):41-55. doi: 10.1007/s13312-010-0008-3.
Revised National Tuberculosis Control Program (RNTCP) has focused on adults with smear positivity a tool not so well used in children with tuberculosis. There is a need to redefine standardization of diagnosis and management protocols for childhood tuberculosis.
Indian Academy of Pediatrics constituted a Working Group to develop consensus statement on childhood tuberculosis (TB). Members of the Group were given individual responsibilities to review the existing literature on different aspects of the childhood TB. The group deliberated and developed a consensus which was circulated to all the members for review. Efforts were made to ensure that the recommendations are standardized.
To produce recommendations and standard protocols for reasonably accurate diagnosis and rational treatment of tuberculosis in children.
Fever and or cough > 2 weeks with loss of weight and recent contact with infectious case should arouse suspicion of TB. Chest Xray and trial with broad-spectrum antibiotic for 7-10 days is justified. In case of clinical and radiological non-response, Mantoux test and sputum or gastric aspirate for AFB is recommended. If AFB is positive, diagnosis is confirmed. If AFB is negative but chest Xray is suggestive and Mantoux test is positive, it is a probable case and if these tests are negative, alternate diagnosis must be sought and referral made to an expert. Ideally it is recommended to use 1TU of PPD for Mantoux test but 2 or 5 TU may be acceptable (but less preferred). Cut-off point of 10 mms for natural infection may be used for test done with 1, 2 or 5 TU. There is no linear relation of reaction to tuberculin strength and so no more than 5 TU should be used. BCG test is not recommended. Diagnosis must not be made without an attempt to look for AFB in gastric aspirate or sputum, as it is possible to get AFB even in primary complex. Elisa and PCR tests for TB are not recommended. There is no place for trial of anti tubercular therapy. Lymphnode enlargement > 2 cm with or without typical findings suggestive of TB and failure of antibiotic response demands FNAC for histopathology and bacteriology. Clinical suspicion of tubercular meningitis (TBM) should be confirmed by CSF examination and CT scan though none of these investigations are confirmatory and hence should not be considered in isolation. CSF tests for TB antibody and PCR are not recommended for routine use. Diagnosis of abdominal TB is made on circumstantial evidence and there are no standard guidelines. For treatment, disease is divided into three categories. The Category I and III are recommended for different types of new cases i.e. those who have received treatment for not more than 4 weeks. Category III includes primary pulmonary complex, one site peripheral lymphadenitis and pleural effusion, while all other forms of TB are included in Category I, that corresponds to smear positive TB in adults. This is because AFB is often found in many Category I disease in children. Category II includes defaulters, relapses and failure cases irrespective of the site of disease. Standard protocol is followed for each of these categories. Intermittent thrice weekly therapy with higher dose has been found to be equally effective as daily therapy and so is recommended in DOTS Direct Observed Therapy Short term. Compliance of treatment must be ensured. Repeat chest X-ray is ideal at the end of therapy. Liver function tests are not routinely recommended. Recommendations are also made for special situations such as MDRTB, TB and HIV and neonate born to mother suffering from TB.
修订后的国家结核病控制规划（RNTCP）主要关注痰涂片阳性的成年人，而在儿童结核病中，这种方法的应用效果并不理想。因此，有必要重新定义儿童结核病的诊断和管理方案。
印度儿科学会成立了一个工作组，旨在制定儿童结核病的共识声明。该工作组的成员被赋予了各自的责任，以审查儿童结核病不同方面的现有文献。该小组进行了审议并达成了共识，该共识随后分发给所有成员进行审查。努力确保建议标准化。
制定合理准确诊断和合理治疗儿童结核病的建议和标准方案。
发热和/或咳嗽> 2 周，体重减轻，近期接触传染性病例，应怀疑结核病。应进行胸部 X 光检查，并试用广谱抗生素 7-10 天。如果临床和影像学无反应，建议进行曼托试验和痰或胃液培养抗酸杆菌。如果抗酸杆菌阳性，则可确诊。如果抗酸杆菌阴性但 X 射线检查提示且曼托试验阳性，则为可能病例；如果这些检查均为阴性，则必须进行其他诊断并转介至专家。理想情况下，建议使用 1TU 的 PPD 进行曼托试验，但也可接受 2 或 5TU（但不太推荐）。对于使用 1、2 或 5TU 进行的测试，可以使用 10mm 的自然感染截断值。结核菌素强度与反应之间没有线性关系，因此不应使用超过 5TU。不建议进行 BCG 测试。如果没有尝试在胃液或痰中寻找抗酸杆菌，就不能做出诊断，因为即使在原发性复合病变中也可能发现抗酸杆菌。不建议进行结核 Elisa 和 PCR 检测。不建议进行抗结核药物试验。如果淋巴结肿大> 2cm，伴有或不伴有典型的结核病表现，且抗生素治疗无效，则需要进行细针抽吸活检以进行组织病理学和细菌学检查。疑似结核性脑膜炎（TBM）应通过脑脊液检查和 CT 扫描进行确认，尽管这些检查均非确诊性检查，因此不应单独进行。不建议常规使用脑脊液检测结核抗体和 PCR。腹部结核病的诊断基于间接证据，目前尚无标准指南。对于治疗，将疾病分为三类。类别 I 和 III 推荐用于不同类型的新病例，即那些接受治疗不超过 4 周的病例。类别 III 包括原发性肺复合病变、一个部位外周淋巴结炎和胸腔积液，而所有其他形式的结核病均归入类别 I，这与成人中痰涂片阳性的结核病相对应。这是因为在儿童中，许多类别 I 疾病中经常发现抗酸杆菌。类别 II 包括失访者、复发者和失败者，无论疾病部位如何。每个类别都遵循标准方案。已发现较高剂量的间歇性每周三次治疗与每日治疗同样有效，因此推荐在 DOTS（直接观察短期治疗）中使用。必须确保治疗的依从性。治疗结束时理想的是重复胸部 X 光检查。不建议常规进行肝功能检查。还针对 MDRTB、TB 和 HIV 以及患有结核病的母亲所生的新生儿等特殊情况提出了建议。
