Importance of childhood TB diagnosis underscored

The Philippines continues to register a high incidence of tuberculosis and this, according to local experts on TB, is due to a number of factors.

Like heart disease and hypertension, tuberculosis is highly prevalent in the Philippines, affecting both adults and children. What makes tuberculosis a cause for concern for the medical community is the public’s lack of knowledge of childhood TB, its diagnosis, and medication.

Dr. Benjamin Sablan Jr., associate professor and coordinator for health services of the University of the Philippines College of Medicine, said, "It is important for the public to get educated on tuberculosis. There is a societal labeling of patients identified to have tuberculosis such that they are feared." He stressed that children with tuberculosis "should not be isolated."

To address the problem of childhood tuberculosis in the Philippines, efforts are being jointly undertaken by local healthcare providers, the private sector, and the government, with the support of international health organizations.

The Philippine Ambulatory Pediatric Association and the Defeat Childhood TB Movement of Pediatrica Inc. are implementing programs for the diagnosis and treatment of childhood TB. Potts Foundation and the Alliance for the Control of Tuberculosis in Children have supported the implementation of projects in Sta. Rosa, Laguna and Mabalacat and Floridablanca, both in Pampanga.

The Department of Health and local government units have implemented these programs following the treatment guidelines stated in the Directly Observed Treatment Short Course in Children or DOTS.

Primarily an airborne disease, tuberculosis is a chronic bacterial infection that usually infects the lungs. "Tuberculosis is an infection with mycobacterium tuberculosis in adults or children," Sablan said. "It can be in the lungs, the brain, anywhere in the liver. You can get an infection anywhere in the body with this particular bacteria."

People infected with mycobacterium tuberculosis may never develop active TB disease. However, in people with weakened immune systems, TB organisms can overcome the body’s defenses, multiply, and cause an active disease.

Tuberculosis is diagnosed with a skin test. Additional tests to determine if a person has TB include X-rays and sputum tests.

Adults and children have equal chances of getting tuberculosis, said Sablan. However, children, since they have a younger immune system, may have a younger set of antibodies, which might not be able to fight the tuberculosis infection as well as adults.

He added: "For children, the complicated disease can be devastating, especially for a child who develops TB meningitis. The effect of TB meningitis may be permanent, especially in a growing child with a growing brain. The effect is more traumatic for children compared to adults."

Sablan underscored the importance of awareness on the proper diagnosis of childhood TB. He cited six criteria that, if present in children, indicate "a high index of suspicion for an active tuberculosis infection."

These criteria are: cough for more than two weeks, fever for more than two weeks, loss of appetite, weight loss, lack of improvement despite treatment for respiratory tract infections, and previous illness such as measles or any debilitating illness. Presence of three out of six of these criteria, he said, is one of the criteria for TB.

Despite its debilitating effects, tuberculosis can be treated. "It is also very important to identify who the adult index case is," Sablan also added. "It can be in the family. It can be a caretaker of the child. You have to treat the adult index case because if you only treat the child, the source of infection is still there."

Response to treatment of tuberculosis is usually clinical based on overall health, weight gain and well-being. The treatment consists of medications prescribed for a six-month period. Patients usually begin to improve within a few weeks of the start of treatment.