Things to know about tuberculosis in children

The article was professionally consulted with Master, Doctor Vu Quoc Anh - Pediatrician - Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital.

Lymph node tuberculosis in children is a form of extrapulmonary tuberculosis with common sites of lymphadenopathy such as cervical, inguinal, and axillary lymph nodes. The disease is not contagious and does not cause death. When young children have infections or allergies, the lymph nodes will become large. Lymph nodes in infants or young children are generally larger than those in adults and can be easily recognized by palpation.

The cause of lymphadenopathy in infants and young children can be due to the body's response to many different things. In infections such as pharyngitis and gingivitis, the lymph nodes may also become larger than normal. They may also get larger in response to a viral infection such as lymphadenitis. Swollen lymph nodes at all times may be related to eczema.
In children, cancer is also the cause of enlarged lymph nodes, but this is very rare. The lymph nodes may persist for more than 1 month after the infection clears.
Tuberculosis in children usually occurs in the neck region. The common inflammatory nodes (due to damage to the gums, mouth, nose, etc.) are the places where TB bacteria easily penetrate, localize and lead to lymph node tuberculosis. The main bacteria that cause lymphadenopathy is Mycobacterium tuberculosis.

Tuberculosis bacilli can enter the lymphatic tract directly through a tuberculous lesion in the oral mucosa, or from a normal lesion due to trauma or infection. Tuberculosis bacilli pass through the oral mucosa into the lymphatic tract (primary lymphadenitis), and sometimes enter the lymphatic system through the oral mucosa without leaving any trace. In addition, tuberculous bacilli can cause multifocal lymphadenitis.

Tuberculosis in children is divided into many types with different signs and symptoms. Common signs of tuberculosis in children can include swollen lymph nodes in the neck region, which may appear one or more lymph nodes. The lymph nodes appear to be gradually enlarged, painless, and very firm. The skin in the lymph node area is swollen, not hot, not red.
The development of tuberculous lymphadenitis in children progresses through 3 stages as follows:
Common lymphadenitis: No inflammation around the lymph nodes, usually in the submandibular or cervical region with one or more enlarged lymph nodes. The lymph nodes are hard, painless, and can be moved under the skin. It is possible that lymph nodes stop at this stage or move to the stage of peri-nodal inflammation. Lymphadenitis and peri-lymph node inflammation: The lymph nodes swell and gather into a mass, many lumps stick deep into the skin due to inflammation around the lymph nodes. Initially, the lymph nodes are hard, painless, then soft and bright. The skin may become ulcerated, leaking pus, pale green, non-sticky, in the pus with pus. The fistula has a purple margin, peels off, can be superinfected causing diffuse lymphadenitis. After the lymph node mass has been eliminated, the fistula hardly leaves keloid scars, white warts or fibrous ligaments. Tumor lymphadenitis in children does not affect the health of children except in cases of superinfection or accompanied by damage to the lungs, bones... Tumor form: Tumor lymphadenitis progresses to hypertrophy. This form is uncommon, the tumor is usually in the neck, is less noticeable, sees one or several enlarged lymph nodes, then adheres to a painless, movable, firm palpable mass and no inflammation around the lymph nodes. The tumor grew, possibly the size of an orange, taking up most of the side of the neck. Other lymph nodes (submandibular, parotid...) are also enlarged. The tumor can be on one side, but sometimes both sides make the neck look like it's spread out, causing asymmetry in the head and face. Tuberculosis of the lymph nodes is very difficult to treat definitively, causing inconvenience in daily activities.

When you see a child with abnormal signs similar to the above, take the child to the nearest medical center for diagnostic tests and treatment planning.
Currently, nodal TB in children can be diagnosed by tests such as:
BK culture X-ray chest x-ray . Do a lymph node biopsy. Lymphocytosis by lymphadenectomy Tests to diagnose lymph node TB in children with the above symptoms should be done quickly. This is very important to serve the differential diagnosis with other diseases and to avoid exacerbation of the disease, making it difficult to treat.

Children need to be nourished, a diet full of nutrients, fortified with vitamins to have good resistance.
Once diagnosed with lymph node tuberculosis, the child needs to rest and follow the treatment regimen of a specialist to get better quickly.

Medical treatment For tuberculosis in children, medical treatment is the mainstay. Treatment must follow the mandatory principles of TB treatment in general. Patients must use a combination of anti-tuberculosis drugs, at least 3 drugs or more. In the attack phase, a combination of 3 to 4 anti-TB drugs should be used, and in the maintenance phase, 2 anti-TB drugs should be used.
The duration of treatment for lymph node TB in children (including the consolidation phase) should be 9-12 months because of lymph node TB or relapse, the duration of treatment depends on the patient's response. But, due to the characteristics of lesions in the lymph nodes, it is difficult for drugs to penetrate into the lymph nodes, so the treatment results are often not as fast as other forms of tuberculosis. During the treatment period for tuberculosis, children must be kept clean, have adequate and reasonable diet.
Surgical treatment Early lymphadenectomy is not recommended in children because the lymph nodes play a protective role against the invasion of tuberculous bacilli.
When the lymph nodes are red, tender, pus-filled and likely to burst, an incision should be made to drain the pus to avoid bad scars later. In case the lymph node has leaked but the pus has not been completely drained, an incision can be made to widen the fistula, drain all the pus and treat it locally, combining anti-tuberculosis drugs as above.
In case of tuberculosis in children with lymph nodes too large, causing pressure on surrounding tissues such as blood vessels and nerves, lymph node dissection should be performed. Note that when performing lymphadenectomy, do not damage blood vessels and nerves.
When treating, it is necessary to pay attention to the health of the child, to avoid making the condition worse.

Nodules are the body's response to adverse conditions or infections. In many cases, the nodules that appear are benign. But take your child to the doctor or call the doctor for advice if the swelling of the lymph nodes is accompanied by one of the following symptoms:
The lymph node is larger than 2.5 cm, or more than 1.2 cm but exists. longer than 1 month. Inflammation of the cervical lymph nodes in children causes difficulty in breathing, affecting the child's swallowing or drinking. Children with fever above 40°C and no signs of relief after 2 hours of taking the medicine, or fever for more than 3 days and no signs of improvement. Reddened skin in the area. The nodule grows rapidly and enlarges after many hours. Swollen lymph nodes cause pain. Child feels sore throat. Large lymph nodes appear in many areas. Lymph nodes in infants, especially those under 1 month old, appear lymph nodes. Previously, the child had no signs or symptoms that would indicate enlarged lymph nodes. Although tuberculosis in children is not life-threatening and the disease is not contagious, it can cause discomfort in children. If not promptly detected, diagnosed and treated, the disease leaves very bad scars and is unsightly.
As a key area of ​​Vinmec Health system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of top doctors and nurses in Pediatrics : consists of leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All doctors are well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.