Primary Complex or Tuberculosis in Children

Tuberculosis, sometimes called primary complex, is a disease that affects people across the world. The World Health Organization (WHO) estimates that 100,000 children die of tuberculosis every year, and Kenyon College in Ohio claims that the disease is responsible for more deaths in young people that any other communicable disease in the world 12. Most child deaths caused by tuberculosis occur in low-income areas such as Southeast Asia, but on rare occasions tuberculosis can affect children in North America.

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Tuberculosis is caused by infection from the bacteria Mycobacterium tuberculosis. It is contracted by inhaling tuberculosis bacilli, the immature form of Mycobacterium tuberculosis, in the air. Tuberculosis bacilli are spread through coughing, sneezing, breathing and talking. Once breathed in, tuberculosis bacilli can sit in the lungs for an extended period of time and may not ever develop into full-blown tuberculosis, as the WHO estimates that only 10 percent of cases develop into the disease. Fewer bacteria sit in the lungs of children infected with the disease, making them less infectious.


In the first stage of tuberculosis in a child, the bacteria infect the lungs. At this point, the bacteria may remain latent. In rare cases, the child's immune system may be strong enough at this point to fight the infection,. Four or five months later, in the next stage, the main symptoms of tuberculosis become apparent. These include pneumonia, liquid on the lungs, and collapse of the lungs. More apparent symptoms include weight loss and heavy coughing. There are no apparent symptoms in the final stage, but the bacteria are usually still present in the lungs and may cause another infection.


Tuberculosis is difficult to diagnose in children because a lot of the methods used to diagnose the disease, such as chest radiographs, have difficulty distinguishing tuberculosis in a child from other chest and lung infections, such as pneumonia. Testing the sputum coughed up by a child is the most reliable method of diagnosing the disease, but this is complicated by the fact that most children cannot produce the amount of sputum needed for the test. Because of these factors, tuberculosis in children is often diagnosed by identifying the symptoms.


It takes a long time to kill the bacteria that lead to tuberculosis. For this reason, it is important to begin treatment as quickly as possible. The drug combinations used to cure tuberculosis in adults are used in smaller doses for children and include drugs such as ethambutol, isoniazid, pyrazinamide, rifampicin and streptomycin. Almost 90 percent of the bacteria are killed within the first two weeks of treatment, according to Kenyon College. However, treatment must be continued for six months to kill the remaining 10 percent. If treatment is not continued then there is a high risk of the re-infection.


Because children are less infectious than adults, children usually pick up the disease from infected adults. For this reason, early diagnosis and treatment of adults with tuberculosis who are in close contact with children is the best way to try to prevent tuberculosis in those children. BCG immunization is a live virus vaccine developed to combat tuberculosis, and the WHO is 2004 recommended that a single dose of BCG should be given to all infants in countries with a high incidence of tuberculosis, except for infants who are confirmed as HIV-positive 3. In countries with low incidence of tuberculosis, the WHO stated that BCG vaccinations could be limited to those infants in high-risk groups: "In some low-burden populations, BCG vaccination has been largely replaced by intensified case detection and supervised early treatment."