Diagnostic Dilemma - Pediatric Oncall
TB CONTACT AT 9 YEARS
Author: Pediatric Oncall
Question
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.
Expert Opinion :
IGRA in this patient was negative. Since the child was otherwise asymptomatic and latent TB was not proven in this child {IGRA was negative and MT was positive which may be due to BCG}, the child was not given prophylaxis. She was followed up for next 12 months and continued to remain asymptomatic.
Answer Discussion :
S
samani omer
given INH for 6months and BCG
4 years ago
S
Shivani Randev
No, the patient can be kept under close regular follow-up
4 years ago
A
Azeem Walele
No treatment required. CXR Normal, Mantoux not contributory because of age. Asymptomatic child.
4 years ago
P
Pravin G Patel
If we advise IGRA and if test will come negative, still we have to respect Positive MT and contact history as negative IGRA does not rule out T.B. infection either active or latent. IGRA is more than 99 percent specific but still false Positive results are possible with M.szulgai, M.kansasii and M.marinum, Regarding sensitivity is at par with MT { some literature say IGRA is atleast at par or better }.Both MT as well as IGRA are usually not recommended in same patient. However positive IGRA can increase compliance to AKT by a relatives of patient from medical field itself{ Positive MT is likely to be disrespected as false positive } , I hope in 9 year child 12 mm MT with 2 T.U.of PPD is definitely not because of B.C.G. vaccination in early infancy . MT as well as IGRA both measures different aspect of immunity and not the same. So any single positive test result with negative other should be taken as Positive . When any one is negative we can go for other to check that we are not dealing with false negative.
4 years ago
F
fificash ad
She should begin prophylactic anti Tb treatment
4 years ago
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