Hard to diagnose TB in children

The state health department has one major worry when it comes to managing tuberculosis (TB): to identify the onset of the disease among children (aged between birth and 15 years). And the officials are worried because this is posing a problem to identify not just regular TB cases but also the extreme drug resistant (XDR) TB cases, which involve TB strains which resist most of the drugs used for treating the disease.

Although the state has right now 4,930 children suffering from TB, who are being treated, the department is in the dark about how many more children are out there who may have contracted the disease, including the XDR TB. This is becoming an increasing concern as close to half-a-million children die of TB yearly across the world. 

A World Health Organisation’s (WHO’s) report 2012-13 on TB states: “The presence of extra pulmonary diseases (among children) is one of the reasons for not being able to diagnose the TB presence as it requires specialist consultation. Lack of linkage between pediatricians and national TB programmes also poses a problem of diagnosis. Childhood TB rarely presents as smear positive and hence is a problem to diagnose.”

The report states that there is a difficulty in establishing a definitive diagnosis for children and that TB may usually occur among children in the age group of 1-4.

Diagnosis is not the only problem. Experts said a good number of these probable child TB patients may also become vulnerable to XDR and multi-drug resistant (MDR) TB, which is a concern.

Because of this major lacunae in the TB identification and management system, the precise number of such patients is logically difficult to establish.

“This is an issue that we are looking into,” said Madan Gopal, principal secretary, health and family welfare department. “We know that since children generally have good immune system, they present the case only when it is too late and when the child has no hope.”

Explaining that TB is a poor man’s disease, Gopal said there are over 370 cases of MDR TB and eight cases of XDR TB in Karnataka.

“If more efficient surveys are done, perhaps we will find more patients in Karnataka. Since the dropout rate from the Directly Observed Therapy (DOT) programme for TB management is high, it is necessary to make sure that patients and their families are taken into confidence, and we also need to ensure that they take the medications on time and finish the course,” he said.

He suggested cross-referral centres cater to HIV patients who are prone to TB. “HIV patients are prone to TB. They are called the deadly twins and we need to fine-tune our programmes to ensure that cross referral programs are done to bring them down,” he said.

“At least 40% of the global TB burden comes from India and China followed by Russia, Brazil and South Africa,” said Dr Dhanya Kumar, director, health and family welfare department.

“The issue is that many private practitioners do not inform the TB centres when they get the patient,” said Dr Shashidhar Buggi, Director, Rajiv Gandhi Institute of Chest Diseases, adding that the disease has become a medico-social issue needing to be addressed by the society as a whole.

Under the Revised National Tuberculosis Control Programme (RNTCP), in Karnataka, 67,572 TB patients have been on treatment with 36,293 of them on DOT.

“We have examined 5,01,736 sputum samples of which 44,664 as sputum positive TB. We completed treatment of 56,081 patients in 2012 which amounts to around 82%,” said MD Suryakanth, sate joint director for tuberculosis control programme.

The Lady Willington State TB Centre is also planning activities to bring down the rate of dropouts from DOT who end up with MDR TB. “We are planning to open a website and have a helpline for TB alone. We are also collaborating with medical colleges for research work on TB,” Suryakanth said.

@deepthimr