Positive MT - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Question
Hello Doctor, I am a confused parent and need some neutral view on the case discussed below: My daughter is exactly 1 year old. Of late she has been eating less (especially solid food).on reporting this to her pediatrician, she suggested a test for manyoux. The story starts here -- An eminent diagnostic center in the city with NABL accreditation reported the test value 10. The Pediatric (who is also a doctor with good repute) said (after measurement) the value is 12. The ESR has been normal. She suggested medication for TB. We went in for a second (and third) opinion. The other two doctors said that mantoux being positive is normal in BCG vaccinated children and since ESR is normal and the chest x-rays are normal with no strong symptoms except a slight drop in food intake. Additionally, they mentioned taking an anti tb dosage may affect the child lever. However, her pediatric feels that no chances should be taken and in children, there is a risk of it spreading to brain which may get dangerous. She also added that the anti TB drugs have no side effects. With all this, I am a confused parent and request the experts to throw light. Please explain.
Answer
A positive MT is seen in all adults in our country due to exposure to TB and is of no use in an adult. However in a child more than 6 months of age (after six months positivity due to BCG is uncommon), a positive MT is taken as exposure to Tb and a 6 month course of TB treatment would be required. Also it would be necessary to screen all members of the family for an X-ray chest to pick asymptomatic TB in an adult as that would be the commonest mode that the child would have acquired TB. Regarding TB drugs causing liver damage, all medications have side effects and when the child is on TB treatment the liver functions would be monitored to watch for any liver dysfunction. The liver side effects are reversible if it occurs if at all and the medication is stopped. Back to All Questions

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