TUBERCULOSIS

Tuberculosis is a contagious disease caused by an acid-fast bacillus, Mycobacterium tuberculosis. The transmission of tuberculosis is through inhalation of droplets from a person with active tuberculosis.

Children are more common infected than adult in family. They can be infected from family member or by another individual with whom they have frequent contact such as babysitter.

Sign and Symptoms:

• May be asymptomatic
• Malaise
• Fever
• Cough
• Weigh loss
• Anorexia
• Lymphadenopathy

Diagnose:

1. Mantoux Test
2. Sputum Culture

Medical Interventions:

1. Isoniazid (INH), rifampin (rifadin), and pyrazinamide
2. A 9 month course of INH is prescribed to prevent a latent infection from progressing to clinically active tuberculosis and to prevent initial infection in children in high risk situations
3. A 12 month course is prescribed to the HIV infected child
4. For child with active tuberculosis: INH, rifampin, and pyrazinamide daily for 2 months and then INH and rifampin twice weekly for 4 months

Nursing Interventions:

1. Wear a mask if the child is coughing and does not cover his or her mouth
2. Place children on airborne precautions until medications have been initiated, sputum cultures demonstrate a diminished number of organisms, and cough is improving
3. Maintain airborne precaution with family members
4. Adequate rest and diet
5. Advice the child and family to prevent transmission of tuberculosis

Mantoux Test:

• Positive reaction to the mantoux test will appear 2-10 weeks after the initial infections
• The test is done to determine whether the child has been infected and has developed a sensitivity to the protein of the tubercle bacillus
• A positive reaction does not confirm the presence of active disease
• Once the child reacts a positively, the child will always react positively
• A positive reaction in a previously negative test indicates that the child has been infected since the last test
• The test should not be done at the same time as measles immunization since it may cause false-negative reaction

Measuring of Mantoux Test:

• The result of the test is measured by indurations:
• 15 cm or more = positive in child 4 years or older who do not have any risk factor
• 10 cm or more = positive in children younger than 4 years and in those with chronic illness or at high risk for exposure to tuberculosis
• 5 cm or more = positive for the highest risk groups such as children with immunusuppressive conditions or human immunodeficiency virus

Sputum Culture:

• The test is positive if it demonstrates the presence of mycobacteria in a culture
• Gastric washing (aspiration of lavaged contents from the fasting stomach) is done to obtain specimen from an infant or young child since they often swallow sputum rather than expectorate it
• The specimen is obtained in the early morning before breakfast