Pediatrics
Tuberculosis in Children
Paediatric tuberculosis for NEET-PG: primary and extrapulmonary TB, Mantoux, CBNAAT, MDR-TB and NTEP notification, mapped to NMC PE34 codes.
MedNext Academy | 3 min read
Tuberculosis in Children
Paediatric tuberculosis for NEET-PG: primary and extrapulmonary TB, Mantoux, CBNAAT, MDR-TB and NTEP notification, mapped to NMC PE34 codes.
This chapter covers tuberculosis in children and adolescents: pulmonary and extrapulmonary forms, drug-susceptible and drug-resistant treatment, prevention with BCG and preventive therapy, and the full diagnostic toolkit from Mantoux and imaging to smear, culture and molecular testing. It is anchored in India's NTEP and Ni-kshay programme framework.
High-yield: Tuberculosis in Children
- Primary paediatric tuberculosis commonly shows hilar lymphadenopathy rather than adult-style upper-lobe cavitation.
- Tuberculous meningitis classically causes basal meningitis with cranial nerve palsies and hydrocephalus.
- Active tuberculosis is never treated with isoniazid monotherapy, because that risks treatment failure and drug resistance.
- Bacille Calmette-Guerin mainly protects young children from severe disseminated tuberculosis, and its scar is sought over the left deltoid region.
- Under-five household contacts are priority contacts even when asymptomatic and are priority candidates for tuberculosis preventive treatment after disease is excluded.
- Mantoux positivity supports tuberculosis infection but cannot distinguish latent infection from active disease, and induration is measured rather than redness.
- Young children with pulmonary tuberculosis often need a gastric aspirate or induced sputum because they swallow sputum rather than expectorate it.
- No routine blood test confirms active tuberculosis in a child, and an elevated erythrocyte sedimentation rate is an inflammation clue, not a tuberculosis stamp.
- Ziehl-Neelsen staining shows acid-fast bacilli as red rods after acid-alcohol decolorisation, but detects a staining behaviour rather than drug resistance.
- Culture provides a viable organism for drug susceptibility testing and is slow because the organism is slow.
- Cartridge-based nucleic acid amplification testing asks whether tuberculosis DNA and rifampicin resistance are present, whereas an interferon-gamma release assay cannot distinguish latent from active disease.
- Rifampicin resistance on molecular testing is a programme emergency that triggers drug-resistant tuberculosis evaluation via the PMDT pathway.
- Rifampicin can discolour urine and tears orange-red, and warning families prevents panic and unnecessary discontinuation.
- Tuberculosis patients should be screened for HIV, and children with HIV should be screened for tuberculosis symptoms.
- In India, tuberculosis is a notifiable disease and diagnosed cases should be linked to the Ni-kshay and National Tuberculosis Elimination Programme systems.
Diagnostic and programme anchors
- **Primary childhood TB:** Hilar lymphadenopathy rather than adult-style upper-lobe cavitation.
- **Mantoux test:** Measures induration, not redness; cannot separate latent from active disease.
- **CBNAAT:** Detects TB DNA and rifampicin resistance in the sample.
- **Notification:** TB is notifiable in India and linked to Ni-kshay and the NTEP.
NMC competencies in this chapter
- **PE34.1:** Pulmonary Tuberculosis in Children and Adolescents
- **PE34.4:** Prevention, Bacille Calmette-Guerin and National Tuberculosis Control Objectives
- **PE34.7:** Mantoux Test Interpretation
- **PE34.13:** Newer Diagnostic Tools: CBNAAT, IGRA and BACTEC Liquid Culture
- **PE34.16:** Multidrug-Resistant Tuberculosis in Children
- **PE34.20:** Tuberculosis Notification and Public-Health Responsibilities
Frequently Asked Questions
How does childhood tuberculosis differ radiologically from adult disease?
Primary paediatric tuberculosis commonly shows hilar lymphadenopathy rather than the adult-style upper-lobe cavitation. In children, hilar nodes are often more important than cavities.
Can the Mantoux test distinguish latent from active tuberculosis?
No. Mantoux positivity supports tuberculosis infection but cannot separate latent infection from active disease. Induration is measured rather than redness, and a negative test does not reassure in tuberculous meningitis, miliary disease, malnutrition or HIV.
Why must active tuberculosis never be treated with isoniazid alone?
Isoniazid monotherapy for active disease risks treatment failure and the development of drug resistance. Isoniazid alone is used only as preventive therapy after active disease has been excluded.
What happens when molecular testing shows rifampicin resistance?
Rifampicin resistance detected on molecular testing is a programme emergency that triggers drug-resistant tuberculosis evaluation through the Programmatic Management of Drug-Resistant Tuberculosis pathway.
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