Table 5 Summary of differences in tuberculosis between adults and children.

Transmission

are frequently contagious because they often have:

- cavitary lesions

- multibacillary disease

- pulmonary tuberculosis

- less circumscribed social networks

- more forceful cough

- productive cough

are infrequently contagious because they often have:

- non-cavitary lesions

- paucibacillary disease

- extrapulmonary tuberculosis

- more circumscribed social networks

- less forceful cough

- non-productive cough

Natural history

- risk of progression is 5-10%

- time between primary infection and disease is often long (some years)

- risk of progression is:

45% in infants < 1 year of age;

24% in children 1-5 years of age;

15% in adolescents

- time between primary infection and disease is often short (1-6 months)

Clinical presentation

- primary infection is often asymptomatic but symptoms and signs are specific

- principally develop pulmonary TB

- primary infection is asymptomatic but it may rapidly progress to symptomatic TB disease with not specific symptoms and signs

- often develop extrapulmonaryand military TB

Diagnosis

- for screening purposes TST or IGRAs are recommended

- detection of M. tuberculosis in sputum smear is achieved in 80% of cases

- chest radiography shows cavitary formations

- in children < 5 years of age only TST is recommended because IGRAs may be unreliable

- in children ˃ 5 years of age and adolescents TST or IGRAs are recommended

- detection in gastric aspirates of M. tuberculosis is achieved in less than 40% of cases

- chest radiography shows unspecific lesions (e.g. hilar or mediastinal lymphadenopathy, bronchopneumonia and pleural fluid collections) or may be normal

Treatment

- treatment for latent TB in close contacts should be unnecessary

- toxicity induced by anti-tubercular drugs is most common

- use of second-line anti-tubercular agents is formally approved

- fixed dose drug combinations are available

- treatment for latent TB is always necessary and in close contacts< 5 years it should be started also if TST is negative

- toxicity induced by anti-tubercular drugs is less common (also ethambutol is considered safe in young children)

- use of second-line anti-tubercular agents is not formally approved

- few fixed dose drug combinations are available