Tuberculosis in Children

Tuberculosis (TB) is an ancient infectious disease with many varied presentations. Although prevention and treatment are available, between 8 and 10 million people still develop TB, and 2 to 3 million people die from it globally, according to the 2022 estimates from the World Health Organization (WHO).[WHO 2023 Global TB Report] For years, children have been thought to contribute little to the global epidemic as they are rarely infectious, and they often clear the infection without treatment. However, without testing and treatment for those children with exposure, a potential reservoir is created from which new future cases will develop, and global efforts at control and eradication will fail. Significant gaps are present between the recognition of children at risk for acquiring TB and their subsequent diagnosis and management. Children, especially those younger than 5, develop TB more readily and in more severe forms than older children and adults. According to the most recent WHO data for children younger than 15, 1.3 million cases of TB were diagnosed, and nearly a quarter million TB-related deaths were reported.[WHO 2023 Global TB Report] The developed world has seen some improvement in diagnosing and preventing TB cases, but no evidence of a decline in high-burden nations has been seen.[WHO 2023 Global TB Report] In fact, high-burden countries have seen significant increases in not only infection and disease but also major increases in multidrug-resistant TB. Poverty, lack of access to adequate medical care, malnutrition, and concurrent infections such as human immunodeficiency virus continue to fuel the infection rates in high-burden countries and pockets throughout the developed world. Pediatric TB case rates are likely underreported in many high-burden countries, and study results have suggested that children may represent as many as 50% of TB cases worldwide.[WHO 2023 Global TB Report] Much work is needed in the diagnosis and management of pediatric TB, as well as addressing the underlying social causes that create the perfect environment for the transmission of TB and the comorbidities that facilitate worse outcomes following infection.