Tuberculosis, especially pulmonary TB, is a problem that arises not only in developing countries, but also in developed countries. Tuberculosis remains one of the causes of high morbidity and mortality. While the highest death rate due to tuberculosis occurs in children under the age of 4 years.
The increasing number of TB cases in various places at this time is thought to be caused by various things, namely incorrect diagnosis; inadequate treatment; prevention programs are not implemented properly; endemic human immuno¬deficiency virus (HIV) infection; population migration; self-medicating (self-treatment); increasing poverty; inadequate health services.
Risk Factors for Tuberculosis Infection
Risk factors for TB include children who are exposed to adults with active TB (positive TB contacts), endemic areas, poverty, unhealthy environments (poor hygiene and sanitation), and public shelters (orphanages, prisons, or hospitals). other nursing homes), where there are many active adult TB patients. The risk of becoming sick is highest at the age of under 3 years and lowest in late childhood.
The most important risk factor for TB infection in children is exposure to infectious adults and is not associated with heredity or other factors in the host. Means, the baby of a mother with smear positive sputum has a high risk of being infected with TB.
Pediatric TB patients rarely transmit germs to other children or adults around them. This is because TB germs are very rarely found in endobrochial secretions, and coughing is rare.
Although TB ranks the lowest among infectious diseases based on the length of time of exposure, long-term exposure in the family environment causes a 30% risk of infection. If the infection occurs in a child, the risk of becoming ill for life is about 10%.
TB disease is usually transmitted through air contaminated with Mycobacterium tuberculosis bacteria which is released when a TB patient coughs, and in children the source of infection generally comes from adult TB patients. These bacteria when often enter and collect in the lungs will multiply into many (especially in people with low immunity), and can spread through blood vessels or lymph nodes. That's why TB infection can infect almost all organs of the body such as: lungs, brain, kidneys, digestive tract, bones, lymph nodes, and others, although the organs most commonly affected are the lungs.
Children who have been infected with TB germs, will not always experience TB disease. The following are factors that can cause the progression of TB infection to become TB disease. The first risk factor is age. Other risk factors are tuberculin test conversion in the last 1-2 years, malnutrition, immunocompromised state (eg in HIV infection, malignancy, organ transplantation, immunosuppressive treatment), diabetes mellitus, chronic renal failure, and silicosis.
Factors that are no less important in the epidemiology of TB are low socioeconomic status, low income, overcrowding, unemployment, low education and lack of funds for public services.
Symptoms of TB disease can be divided into general symptoms and specific symptoms that arise according to the organs involved. The clinical picture is not very typical, especially in new cases, so it is quite difficult to establish a clinical diagnosis.
Common Symptoms
Fever is not too high that lasts a long time, usually felt at night accompanied by night sweats. Sometimes fever attacks are like influenza and are intermittent. Decreased appetite and weight. Coughing for more than 3 weeks (may be accompanied by blood). Feeling unwell (malaise), weakness.
Specific Symptoms
Depending on which organs of the body are affected, if there is blockage of part of the bronchi (the tubes leading to the lungs) due to suppression of enlarged lymph nodes, it will cause a “wheezing” sound, weakened breath sounds accompanied by shortness of breath. If there is fluid in the pleural cavity (wrapping the lungs), it can be accompanied by complaints of chest pain. When it hits the bone, symptoms such as bone infection will occur which at one time can form a channel and lead to the skin above it. In children it can affect the brain (the covering of the brain) and is referred to as meningitis (inflammation of the lining of the brain), the symptoms are high fever, decreased consciousness and convulsions.
In pediatric patients who do not cause symptoms, TB can be detected if there is known contact with adult TB patients. Approximately 30-50% of children who are in contact with adult pulmonary tuberculosis patients give a positive tuberculin test result. In children aged 3 months 5 years who live at home with adult pulmonary TB patients with smear positive, 30% are reported to be infected based on serological/blood tests.
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