Defining various categories of tuberculosis in children:

A. Asymptomatic Mantoux Positivity: Implies that the patient has no tuberculous lesion and is only a tuberculin positivity.

B. Symptomatic Mantoux positive - Presence of fever, cough, loss of weight, chest infection not responsive to antibiotics with Mantoux positivity.

C. Pulmonary Primary Complex (PPC) - is suspected when the following criteria are met with

i) Essential criteria:

• Symptoms of fever, cough, loss of weight, chest infection not responding to antibiotics.
• X-ray lesion suggesting tuberculosis such as hilar adenopathy or parenchymal opacity.

ii) Supportive criteria:

• Positive Mantoux test
• Superficial lymphadenitis proven to be tuberculous etiology
• Positive Family history of tuberculosis
• Grade III or IV malnutrition
• Non vaccination with BCG

D. Progressive Pulmonary Disease (PPD)- Progression of the PPC lesion is defined as progressive pulmonary disease (PPD) nodal lesions progressing to

• Bronchial obstruction
• Atelectasis
• Bronchiectasis
• Endobronchial tuberculosis
• Spread to adjacent areas.

Paranchymal lesion may progress to

• Lobar consolidation
• Bronchopneumonia
• Pleural effusion.

E. Disseminated/Miliary tuberculosis -
The term is used when more than one organ or non cotiquous body tissues are involved with tuberculosis. Miliary tuberculosis is a specific form of disseminated tuberculosis with classical radiological findings.

Presentation:

• Acute with respiratory distress, weight loss fever etc
• Cryptic type with no pulmonary findings,
• presenting with hepatosplenomegaly, lymphadenopathy, meningitis, pleural, pericardial and other organ involvement.
• Fundoscopy often reveals choroid tubercles.
• Diagnosis:
• Tuberculin often negative
• Direct smear for AFB may be positive
• Biopsy of the Bone marrow, liver, lymphnode, may reveal typical granulomas from which the AFB should be demonstrated.

F. Neurotuberculosis may be of several types -
•  Meningitis
•  Encephalopathy
•  Serous TB meningitis
• Tuberculoma
• Radiculomyelitis

G. Others -
•Abdominal tuberculosis
• Genitourinary tuberculosis
• Pericardial
• Osteoarticular tuberculosis