Worldwide COVID has fallen to second place as the top cause for infectious disease-related deaths in 2023. Good news but guess which infectious disease now leads in infectious disease deaths…tuberculosis. We tend to think of TB as a disease of the past. We know of such famous historical figures as “Doc” Holliday, Wyatt Earp, Chopin, Keats succumbed a disease that consumed them. That’s why it was called “consumption”.
Last year worldwide there were about 8.2 million people with newly diagnosed tuberculosis. This is up about a million since 2022. In the US in 2021 there were about 9000 new cases. Children ages 14 years or younger are about 4-5% of this number.
Children and teens at higher risk include those who are living in a household with an adult with active tuberculosis, those born in a country with a high prevalence of TB associated with HIV and drug resistant TB and those visiting a country where TB is common and have extended contact with persons living there. Children who are at higher risk for having severe disease are those younger than 4 years and teen agers who have started puberty. Also children who have problems with their immune system such as those taking medicines that decrease their body’s immune system.
Tuberculosis is usually spread when an infected adult coughs the bacteria into the air. These germs are inhaled and others become infected. Children younger than 12 years rarely infect other people. It appear that is because they have fewer germs in their secretions and their cough is not as powerful spewing out fewer germs.
Most children exposed to TB do not become ill and the only way to tell if these symptom-free children have TB is by a skin test or a blood test. Even children that are symptom-free need to be treated as there is a possibility that in the future the infection will get worse and turn into disease. Eleanor Roosevelt actually died of TB after she was treated with steroids for another disease. This allow the tuberculosis to become activated from an infection she had had almost 50 years before. The culture of her TB also showed that it was resistant to two of the common treatments for TB, streptomycin and isoniazid.
For diagnosis in a child younger than 2 years the child should be tested by a TB skin test. If older than 2 years a blood test called IGRA should be done. A positive IGRA blood test or TB skin test means the child’s body has experienced the bacteria even if there are no symptoms. If they are positive further work up will be needed to determine the type of treatment.
TB can be controlled for many years by the immune system only to break through during other stressful times for the immune system such as adolescence, pregnancy, and later adulthood. Many medications given for chronic diseases suppress the immune system.
With any possible exposure to TB, get tested.
by Sally Robinson, MD Clinical Professor
Keeping Kids Healthy
Published 11/2024
Also See:
UTMB Pediatrics - Pediatric Primary Care
UTMB After Hours Urgent Care