Tuberculosis (pediatrics)

Tuberculosis (TB; TBC in Czech) is a chronic infectious disease caused by Mycobacterium tuberculosis. It affects mostly the lungs, extrapulmonary forms are less common and can affect any organ. Due to high vaccination rate of the Czech population the overall presence of TB is very low and extrapulmonary forms are rather exceptional. Higher rates of TB infection are notable among the elderly, the homeless, people addicted to alcohol or other addictive substances, the underprivileged and the immigrants. The diagnosis of TB is based on positive epidemiological anamnesis, chest X-ray, tuberculin test, bacteriological proof, biopsy and histological testing, and auxilliary examination methods. A combination of antibiotics is used as a treatment, which lasts at least 9 months. In the Czech republic, a vaccine is available, although it is not a part of the obligatory vaccination program.

A disease caused by related non-tuberculotic bacteria is called mycobacteriosis.

Etiology

 * Mycobacterium tuberculosis („Koch's bacillus“) is an acidoresistant rod-shaped bacteria;
 * small, immobile, slow growing bacillus;
 * very resistant against acidic environment;
 * when stained by the Ziehl-Neelsen method the rods are red against a blue background;
 * the M. tuberculosis complex includes:
 * M. bovis, M. africanum, M. microti, M. canetti;
 * M. bovis used to be a fairly common cause of infection before the advent of milk pasteurization;
 * non-tuberculotic mycobacteria:
 * Mycobacterium avium and M. kansasii – they cause severe illness which includes damage to lymphatic nodes as well as lung tissue (mycobacterioses);
 * M. leprae – the cause of leprosy.

Epidemiology

 * risk factors: weakened immunity, malnutrition, HIV positivity (at least ⅓ of people suffering from AIDS has an active tuberculosis), intravenous drug abuse, diabetes mellitus, chronic renal failure, cancer, lung silicosis, biological therapy by TNF-α inhibition;
 * transmission: droplet infection – contact with a diseased person that secretes M. tuberculosis into the sputum (active untreated TB);
 * the risk increases with the amount of bacteria and the frequency of exposition – the most dangerous are sources within families (a child is in frequent contact with the diseased person);
 * the source isn't usually discovered in extrapulmonary TB.