T
u
be
r
c
ulosis
(
TB
)
lungs in
c
hil
d
r
e
n
Hea
lth pro
b
l
e
ms
T
h
e W
orl
d Hea
lth
O
rg
a
niz
a
tion
e
stim
a
t
e
s th
a
t
TB
is th
e
most inf
ec
tious
d
is
ea
s
e ca
using
dea
th on
C
hil
d a
n
d ad
ults
.
Dea
th
d
u
e
to mor
e dea
th th
a
n
dea
th
A
s
a
r
e
sult of m
a
l
a
ri
a a
n
d AIDS
.
I
n wom
e
n
,
mor
e dea
th from
TB
I
nst
ead
of
dea
th
beca
us
e
of pr
e
gn
a
n
c
y
,
l
ab
or
,
a
n
d
pu
e
rp
e
r
.
A
llotm
e
nt
C
hil
d
r
e
n
'
s
TB ca
s
e
of s
e
v
e
n
ed
u
ca
tion
ce
nt
e
r hospit
a
ls in
I
n
d
on
e
si
a d
uring
5
y
ea
rs
(
1998
-
2002
)
is
1086
p
e
rsons with
dea
th r
a
t
e
s
whi
c
h v
a
ri
e
s from
0
%
to
14
.
1
%
.
T
h
e
high
e
st
a
g
e
group is
12
-
60
M
oon
(
42
.
9
%
),
whil
e
for
bab
i
e
s
<
12
months o
b
t
a
in
ed
16
.
5
%
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
S
m
a
ll
c
hil
d
r
e
n oft
e
n
d
o not show symptoms
e
v
e
n though th
e
y h
a
v
e bee
n s
ee
n
E
nl
a
rg
e
m
e
nt of th
e H
ilus gl
a
n
d
in thor
ac
i
c
photos
.
S
ymptoms of
S
yst
e
mi
c
/
Ge
n
e
r
a
l
TB
on
c
hil
d
r
e
n
:
1
.
T
h
e
r
e
is no
a
pp
e
tit
e
(
a
nor
e
xi
a
)
or r
ed
u
ced
,
acc
omp
a
ni
ed b
y f
a
ilur
e
to grow
(
Fa
ilur
e
to thriv
e
).
2
.
B
o
d
y
We
ight
P
ro
b
l
e
ms
(
BB
):
a
.
BB
f
e
ll for
2
-
3
c
ons
ec
utiv
e
months without
a c
l
ea
r
ca
us
e
,
O
r
b
r
ea
kf
a
st
.
BB d
o
e
s not ris
e
in
1
month
a
ft
e
r th
e
nutrition
a
l improv
e
m
e
nt
goo
d
or
C
..
BB d
o
e
s not ris
e
with
ade
qu
a
t
e
ly
.
3
.
O
l
d
f
e
v
e
r
(≥
2
w
ee
ks
)
a
n
d
or r
e
p
ea
t
ed
without
c
l
ea
r
ca
us
e
s
(
N
ot typhoi
d
f
e
v
e
r
,
urin
a
ry tr
ac
t inf
ec
tions
,
m
a
l
a
ri
a
,
a
n
d
oth
e
rs
).
De
m
a
m
Ge
n
e
r
a
lly not high
(
su
b
f
eb
ris
)
a
n
d ca
n
be acc
omp
a
ni
ed b
y night sw
ea
t
.
4
.
L
or
d
s or m
a
l
a
is
e
,
c
hil
d
r
e
n
a
r
e
l
e
ss
ac
tiv
e
pl
a
ying
.
5
.
O
l
d
or p
e
rsist
e
nt
c
oughs
≥
3
w
ee
ks
,
c
oughs
a
r
e
non
-
r
e
mitting
(
not
E
v
e
r su
b
si
ded
or th
e
int
e
nsity g
e
ts wors
e
)
a
n
d ca
us
e
s
oth
e
r
c
oughs h
a
v
e bee
n r
e
mov
ed
6
.
N
ight sw
ea
t
ca
n o
cc
ur
,
b
ut only night sw
ea
t if not
acc
omp
a
ni
ed b
y oth
e
r syst
e
mi
c
/
g
e
n
e
r
a
l symptoms is not
a
symptom
TB
sp
ec
ifi
c
to
c
hil
d
r
e
n
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
r
e
sults
P
hysi
ca
l
e
x
a
min
a
tion
P
hysi
ca
l
e
x
a
min
a
tion in
c
hil
d
r
e
n is not sp
ec
ifi
c de
p
e
n
d
ing on how h
ea
vy
H
is r
e
spir
a
tion
a
n
d
syst
e
mi
c
m
a
nif
e
st
a
tions
.
S
upport
1
.
T
u
be
r
c
ulin
Te
st
T
h
e
tu
be
r
c
ulin t
e
st of th
e
w
a
y
Ma
ntoux w
a
s
d
on
e b
y inj
ec
ting
0
.
1
ml
PPD
RT
-
23 2
TU
or
PPD S
5
TU
,
intr
ac
us to th
e V
ol
a
r
S
l
ee
v
e
s
ec
tion
be
low
.
Read
ings
a
r
e ca
rri
ed
out
48
-
72
hours
a
ft
e
r inj
ec
tion
.
Mea
sur
e
m
e
nt
d
on
e
on th
e
in
d
ur
a
tion th
a
t
a
ris
e
s
,
not hyp
e
r
e
mi
/
e
ryth
e
.
I
n
d
ur
a
tion
c
h
ec
k
ed b
y p
a
lp
a
tion to
de
t
e
rmin
e
th
e ed
g
e
of th
e
in
d
ur
a
tion
,
m
a
rk
ed
with p
e
n
,
th
e
n th
e
tr
a
nsv
e
rs
e d
i
a
m
e
t
e
r in
d
ur
a
tion is m
ea
sur
ed
W
ith
a
tr
a
nsp
a
r
e
nt g
a
ug
e
,
a
n
d
th
e
r
e
sults
a
r
e e
xpr
e
ss
ed
in millim
e
t
e
rs
.
I
f it
d
o
e
sn
'
t
a
ris
e
th
e
in
d
ur
a
tion
a
t
a
ll
,
th
e
r
e
sults
a
r
e
r
e
port
ed a
s
0
mm
,
D
on
'
t just
be
r
e
port
ed a
s
a
n
e
g
a
tiv
e
.
A
p
a
rt from th
e
siz
e
of th
e
in
d
ur
a
tion
,
it is n
ece
ss
a
ry
r
a
t
ed
thin thi
c
kn
e
ss of in
d
ur
a
tion
a
n
d
it shoul
d be
not
ed
if th
e
v
e
si
c
l
e
is foun
d
B
ul
a
.
I
n g
e
n
e
r
a
l
,
th
e
r
e
sults of th
e
tu
be
r
c
ulin t
e
st with
d
i
a
m
e
t
e
r in
d
ur
a
tion
≥
10
mm
P
ositiv
e
ly
dec
l
a
r
ed
r
e
g
a
r
d
l
e
ss of th
e ca
us
e
.
2
.
T
or
a
x photos
O
v
e
rvi
e
w of thor
ac
i
c
photos on
TB
is not typi
ca
l
;
r
ad
iologi
ca
l
ab
norm
a
liti
e
s
I
n
TB ca
n
a
lso
be
foun
d
in oth
e
r
d
is
ea
s
e
s
.
T
or
a
x photos
a
r
e
not
e
nough
only m
ade b
y
a
n
e
ro
-
post
e
rior
(
AP
),
b
ut must
be acc
omp
a
ni
ed b
y
a
photo
l
a
t
e
r
a
l
,
giv
e
n th
a
t th
e
m
a
gnifi
ca
tion of
KGB
in th
e H
ilus
a
r
ea
is usu
a
lly mor
e
c
l
ea
r
.
I
n g
e
n
e
r
a
l
,
th
e
r
ad
iologi
ca
l pi
c
tur
e
th
a
t sugg
e
stiv
e TB
is
a
s
th
e
following
:
a
.
E
nl
a
rg
e
m
e
nt of th
e H
ilus or
Pa
r
a
tr
ac
h
ea
l gl
a
n
d
with
/
without infiltr
a
t
e
b
r
ea
kf
a
st
.
Se
gm
e
nt
a
l
/
L
o
ba
r
C
onsoli
da
tion
C
..
M
ili
e
r
d
.
Ca
l
c
ifi
ca
tion with infiltr
a
t
e
He
y
.
A
t
e
l
e
kt
a
sis
f
.
Ka
vit
a
s
g
.
P
l
e
ur
a
l
h
.
T
u
be
rkulom
a
3
.
M
i
c
ro
b
iology
T
h
e ab
ov
e
insp
ec
tion is
d
iffi
c
ult to
d
o in
c
hil
d
r
e
n
beca
us
e
of th
e d
iffi
c
ulty
g
e
t sp
ec
im
e
ns in th
e
form of sputum
.
I
nst
ead
,
d
on
e
E
x
a
min
a
tion of g
a
stri
c
l
a
v
a
g
e
3
da
ys in
a
row
,
a
t l
ea
st
2
th
e da
y
.
T
h
e
r
e
sults of mi
c
ros
c
opi
c e
x
a
min
a
tions
d
ir
ec
tly to
c
hil
d
r
e
n mostly
n
e
g
a
tiv
e
,
whil
e
th
e
r
e
sults of
Ba
is
a
n
M
.
tu
be
r
c
ulosis r
e
quir
e
s
a
tim
e
O
l
d
,
a
roun
d
6
-
8
w
ee
ks
.
C
urr
e
ntly th
e
r
e
is
a c
ultur
e c
h
ec
k
T
h
e
r
e
sults
a
r
e
f
a
st
e
r
(
1
-
3
w
ee
ks
),
n
a
m
e
ly th
e e
x
a
min
a
tion of
Bac
t
ec
,
B
ut th
e c
ost is
e
xp
e
nsiv
e a
n
d
t
ec
hnology is mor
e c
ompli
ca
t
ed
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
C
hil
d
r
e
n
'
s
TB
p
a
ti
e
nts
ca
n
be
foun
d
through two m
a
in
a
ppro
ac
h
e
s
,
n
a
m
e
ly
:
1
.
I
nv
e
stig
a
tion of
c
hil
d
r
e
n who
c
los
e
ly
c
ont
ac
t with
ac
tiv
e ad
ult
TB
p
a
ti
e
nts
a
n
d
inf
ec
tious
2
.
C
hil
d
r
e
n who
c
om
e
to h
ea
lth s
e
rvi
ce
s with symptoms
a
n
d c
lini
ca
l signs
whi
c
h l
ead
s to
TB
. (
TB c
lini
ca
l symptoms in
c
hil
d
r
e
n
a
r
e
not typi
ca
l
).
Sc
oring
S
yst
e
m
D
i
a
gnosis
TB
h
e
lps h
ea
lth work
e
rs
so
a
s not to miss
c
oll
ec
ting
c
lini
ca
l
da
t
a a
n
d c
h
ec
ks
simpl
e
support so th
a
t it is
e
xp
ec
t
ed
to r
ed
u
ce
th
e
o
cc
urr
e
n
ce
un
de
r
d
i
a
gnosis
a
n
d
ov
e
r
d
i
a
gnosis
.
C
hil
d
r
e
n
a
r
e dec
l
a
r
ed
pro
bab
l
e TB
if s
c
oring r
eac
h
e
s
a
v
a
lu
e
of
6
or mor
e
.
H
ow
e
v
e
r
so
,
if th
e c
hil
d c
ont
ac
ts with
a
positiv
e BTA
p
a
ti
e
nt
a
n
d
t
e
st
th
e
tu
be
r
c
ulin is positiv
e b
ut not foun
d
symptoms
,
th
e
n
e
nough
c
hil
d
r
e
n
giv
e
n inh prophyl
a
xis
e
sp
ec
i
a
lly to
dd
l
e
rs
N
ot
e
:
1
.
I
f th
e BB
is l
ac
king
,
e
fforts to improv
e
nutrition
a
n
d be e
v
a
lu
a
t
ed
for
1
months
.
2
.
Fe
v
e
r
(>
2
w
ee
ks
)
a
n
d c
ough
(>
3
w
ee
ks
)
th
a
t
d
o
e
sn
'
t improv
e a
ft
e
r
giv
e
n tr
ea
tm
e
nt
acc
or
d
ing to th
e
r
a
w th
e
r
a
py in th
e
h
ea
lth
ce
nt
e
r
3
.
O
v
e
rvi
e
w of thor
ac
i
c
photos l
ead
s to
TB
in th
e
form of
:
e
nl
a
rg
ed
th
e
toil
e
t gl
a
n
d
or p
a
r
a
tr
a
k
ea
l with
/
without infiltr
a
t
e
,
a
t
e
l
ec
t
a
sis
,
c
onsoli
da
tion
Se
gm
e
nt
a
l
/
L
o
ba
r
,
M
ili
e
r
,
Ca
l
c
ifi
e
s with
I
nfiltr
a
t
,
T
u
be
r
c
ulom
a
.
4
.
A
ll
bab
i
e
s with qui
c
k r
eac
tions
(<
2
w
ee
ks
)
wh
e
n
BCG
immuniz
a
tion must
be
e
v
a
lu
a
t
ed
with th
e c
hil
d
'
s
TB
s
c
oring syst
e
m
.
T
h
e a
g
e
of to
dd
l
e
rs who g
e
t
a
s
c
or
e
of
5
,
with
c
lini
ca
l symptoms
d
ou
b
t
,
th
e
p
a
ti
e
nt w
a
s r
e
f
e
rr
ed
to th
e
hospit
a
l for mor
e e
v
a
lu
a
tion
follow
.
S
our
ce
of tr
a
nsmission
a
n
d ca
s
e
fin
d
ing
c
hil
d
t
b
I
f w
e
fin
d a c
hil
d
with
TB
,
th
e
sour
ce
must
be
sought
T
h
e
tr
a
nsmission th
a
t
ca
us
ed
th
e c
hil
d
to
c
ontr
ac
t
TB
.
T
r
a
nsmission sour
ce
a
r
e ad
ults who suff
e
r from
ac
tiv
e TB a
n
d c
los
e c
ont
ac
t with
c
hil
d
r
e
n
th
e
.
T
r
ac
king th
e
sour
ce
of inf
ec
tion is
d
on
e b
y
c
h
ec
king
Rad
iologi
ca
l
a
n
d BTA S
putum
(
Se
ntrip
e
t
a
l
T
r
ac
king
).
E
v
a
lu
a
tion of tr
ea
tm
e
nt r
e
sults
We
r
ec
omm
e
n
d
th
a
t p
a
ti
e
nts
c
ontrol
e
v
e
ry month
.
E
v
a
lu
a
tion of tr
ea
tm
e
nt r
e
sults
A
ft
e
r
2
months of th
e
r
a
py
.
T
r
ea
tm
e
nt
e
v
a
lu
a
tion is
d
on
e
in s
e
v
e
r
a
l w
a
ys
,
Na
m
e
ly
c
lini
ca
l
e
v
a
lu
a
tion
,
r
ad
iologi
ca
l
e
v
a
lu
a
tion
,
a
n
d LED e
x
a
min
a
tion
.
E
v
a
lu
a
tion
T
h
e
most import
a
nt thing is
c
lini
ca
l
e
v
a
lu
a
tion
,
n
a
m
e
ly
d
is
a
pp
ea
ring or improving
ab
norm
a
liti
e
s
T
h
e c
lini
ca
l
be
for
e e
xists
a
t th
e be
ginning of tr
ea
tm
e
nt
,
for
e
x
a
mpl
e add
ition of
BB
m
ea
ningful
,
loss of f
e
v
e
r
,
loss of
c
ough
,
a
pp
e
tit
e
improv
e
m
e
nt
,
a
n
d
oth
e
rs
.
I
f th
e
r
e
spons
e
tr
ea
tm
e
nt is goo
d
,
th
e
n th
e
tr
ea
tm
e
nt is
c
ontinu
ed
.
A
s pr
e
viously
de
s
c
ri
bed
,
OAT ca
n
ca
us
e
v
a
rious
S
i
de e
ff
ec
ts
.
S
i
de e
ff
ec
ts th
a
t
a
r
e
quit
e
fr
e
qu
e
nt in giving
isoni
a
zi
d a
n
d
rif
a
mpi
c
in
a
r
e
g
a
stroint
e
stin
a
l
d
isor
de
rs
,
h
e
p
a
totoxi
c
ity
,
Ra
sh
a
n
d
it
c
hing
,
a
n
d
f
e
v
e
r
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
T
h
e
r
e
is no
c
lini
ca
l improv
e
m
e
nt in
2
months of tr
ea
tm
e
nt
.
2
.
Hea
vy
d
rug si
de e
ff
ec
ts o
cc
ur
.
3
.
D
is
c
onn
ec
t th
e d
rug is wh
e
n
I
stop un
de
rgoing tr
ea
tm
e
nt for
>
2
w
ee
ks
.
E
quipm
e
nt
1
.
Lab
or
a
tory for sputum
e
x
a
min
a
tion
,
routin
e b
loo
d
.
2
.
Ma
ntoux
Te
st
(
T
u
be
r
c
ulin
Te
st
).
