Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A 9 years old girl was screened for tuberculosis as brother had open TB. Her Chest X-Ray was normal and Mantoux test was 12 mm. Child was otherwise asymptomatic.
Answers of this discussion
Author :- pawan kumar on 25 September 2012.
Answer :- She should be ginen INH only and other diagnostic tests for TB must be done and proper follow up should be done.

Author :- sehrish cheema on 26 September 2012.
Answer :- Should be started with prophylactic Anti tuberculosis therapy with INH for 6 months

Author :- bharat sukhija on 26 September 2012.
Answer :- nope

Author :- shaukat panjawani on 27 September 2012.
Answer :- yes,she should be given 6HR,for asymptomatic positive mantoux with close contact exposure.

Author :- enas eljalal on 27 September 2012.
Answer :- no treatment

Author :- Pravin G Patel on 27 September 2012.
Answer :- Child does not require AKT at this point of time . However child require monitoring and AKT can be started later on if child becomes symptomatic .One should contine Reassess situation every 2-3 Monthly

Author :- Pravin G Patel on 28 September 2012.
Answer :- Prophylactic AKT can be concidered if history of Chickenpox in last 1 months or immunosuppresing medicines taken for other causes. If any way prophylactic AKT is decided it should not be a choice for single drug as can develop resistance.I will recommend minimum of 2 drug regime of INHplusRIFA for period of 3 months

Author :- Pediatric Oncall on 01 October 2012.
Answer :- MT of 12 mm may be positive, but one needs to evaluate whether it is due to 2 tuberculin unit, 5 or 10 TU. ALso what would be the effect of BCG at this age for a positive mantoux test_? This child had received MT by 2 TU. Now what would be your comments. There is no immunosuppression, chickenpox.

Author :- Pravin G Patel on 01 October 2012.
Answer :- 12 mm, MT positivity with as little as 2 T.U. in 9 year child with plus ve contact history will shift balance of judgement in favour of LATENT T.B.INFECTION and will require 2 drug AKT {INHplusRIFA } for 6 or 9 months . 12 mm positivity is simply erythema only or induration also needs to be confirmed .Personal viewing of MT site is essencial as non clinical techanician simply see erythema which can be because of needle trauma

Author :- nadir brivkani on 02 October 2012.
Answer :- no need to give her treatment just she need follow up

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