Intended for healthcare professionals

Education And Debate

Lesson of the Week: Pitfalls in contact tracing and early diagnosis of childhood tuberculosis

BMJ 1996; 313 doi: (Published 27 July 1996) Cite this as: BMJ 1996;313:221
  1. Julia E Clark, paediatric senior registrara,
  2. Andrew J Cant, consultant in paediatric infectious diseases and immunologya
  1. aDepartment of Paediatrics, Newcastle General Hospital, Newcastle NE4 6BE
  1. Correspondence to: Dr Cant.
  • Accepted 6 February 1996

The incidence of tuberculosis in Western countries has steadily declined, but this trend is reversing.1 Effective contact tracing and screening remain essential to prevent secondary cases and are especially important for child contacts, given their greater susceptibility to disseminated disease and the difficulty in diagnosis in this age group.

We describe three cases of serious tuberculous disease in children that illustrate their vulnerability to this infection and the problems that can be encountered with apparently straightforward contact tracing procedures.

Tuberculosis is easily missed in children; a combination of contact history, tuberculin testing, and radiology aid diagnosis

Case 1

A 5 month old Asian girl who had not been vaccinated for tuberculosis was seen as a contact of her grandmother, who had fully sensitive pulmonary tuberculosis. She was well at this time and after one negative result on Heaf testing (grade 0) was given a BCG vaccination and discharged.

Six weeks later she presented to her general practitioner with fever, poor feeding, and vomiting. She was referred to hospital. On examination she was pale and unwell and tachypnoiec, with widespread crepitations on auscultation, but no hepatosplenomegaly. A chest x ray film showed extensive miliary shadowing, with a small opacity in the right mid zone. Miliary tuberculosis was diagnosed. A nine month course of triple antituberculous chemotherapy produced a full recovery.

Case 2

A 6 year old white girl was screened as a contact of an aunt who had fully sensitive smear positive pulmonary tuberculosis. Two Heaf tests six weeks apart gave negative results, and she was given a BCG vaccination. Two weeks later she presented at her local hospital with a history of cough, headaches, weight loss, and fever. A chest x ray film showed right middle lobe consolidation. The family history of tuberculosis was not volunteered or asked …

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