Changes in the Screening for Tuberculosis in Children
Changes in the Screening for Tuberculosis in Children
The organism that causes Tuberculosis (TB), mycobacterium tuberculosis, has affected people for thousands of years. It was seen in Egyptian mummies and is described by Hippocrates (NJMS National Tuberculosis Center, 2000). It is a contagious disease spread primarily by droplet nuclei expelled by someone who has infectious pulmonary or laryngeal TB when they cough, sneeze, laugh, sing, or speak. Therefore, close contacts are at the highest risk of becoming infected. In the hospital setting, it can also be spread by "aerosol treatments, sputum induction, aerosolization during bronchoscopy, and through manipulation of lesions or processing of tissue or secretions" (American Thoracic Society, 2000, p. 1377).
The body can usually contain the infection; some of the tubercle bacilli are phagocytized by macrophages, but others multiply within the alveolar macrophages. When the macrophage dies, the bacilli can spread through the lymph channels and the bloodstream to distant sites, in which TB disease can develop (i.e., the brain, kidneys, or bone). During the period when the organism is being contained by the immune system, individuals are not considered to have TB disease and cannot spread the infection; they are not considered to be a case of TB. However, they do have circulating antibodies and react positively when given a tuberculin skin test. They are referred to as having a latent TB infection (U.S. Department of Health and Human Services [USDHHS], 2000). It is important for the nurse to differentiate TB infection from TB disease. The Classification System for TB is found in Table 1 .
TB disease in children often presents differently than for adults. This is especially true for those under age 4 who have a higher incidence of converting from TB infection to TB disease due to their underdeveloped immune systems. Young children usually do not produce sputum and those under age 12 are rarely infectious; they have fewer tubercle bacilli in their lungs and usually lack the force to expel the bacilli with a cough. Children are rarely symptomatic and therefore often present in the later stages of the disease (NJMS National Tuberculosis Center, 2001).
Introduction
The organism that causes Tuberculosis (TB), mycobacterium tuberculosis, has affected people for thousands of years. It was seen in Egyptian mummies and is described by Hippocrates (NJMS National Tuberculosis Center, 2000). It is a contagious disease spread primarily by droplet nuclei expelled by someone who has infectious pulmonary or laryngeal TB when they cough, sneeze, laugh, sing, or speak. Therefore, close contacts are at the highest risk of becoming infected. In the hospital setting, it can also be spread by "aerosol treatments, sputum induction, aerosolization during bronchoscopy, and through manipulation of lesions or processing of tissue or secretions" (American Thoracic Society, 2000, p. 1377).
The body can usually contain the infection; some of the tubercle bacilli are phagocytized by macrophages, but others multiply within the alveolar macrophages. When the macrophage dies, the bacilli can spread through the lymph channels and the bloodstream to distant sites, in which TB disease can develop (i.e., the brain, kidneys, or bone). During the period when the organism is being contained by the immune system, individuals are not considered to have TB disease and cannot spread the infection; they are not considered to be a case of TB. However, they do have circulating antibodies and react positively when given a tuberculin skin test. They are referred to as having a latent TB infection (U.S. Department of Health and Human Services [USDHHS], 2000). It is important for the nurse to differentiate TB infection from TB disease. The Classification System for TB is found in Table 1 .
TB disease in children often presents differently than for adults. This is especially true for those under age 4 who have a higher incidence of converting from TB infection to TB disease due to their underdeveloped immune systems. Young children usually do not produce sputum and those under age 12 are rarely infectious; they have fewer tubercle bacilli in their lungs and usually lack the force to expel the bacilli with a cough. Children are rarely symptomatic and therefore often present in the later stages of the disease (NJMS National Tuberculosis Center, 2001).
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