Tuberculosis - persistent threat to human health.

With the increasing incidence of tuberculosis worldwide, childhood cases now constitute 40% of the total. TB control thus has global importance. Unfortunately, control of disease is not in sight. It was always thought that adult tuberculosis is the fountainhead of childhood tuberculosis but it is being increasingly realized that it is the infection acquired during childhood that promotes reactivation of adult disease, which in turn maintains the chain of transmission.Thus childhood tuberculosis needs equal or more attention for effective control. Early detection by simple tests and ensuring treatment compliance is the goal. The small number of bacilli and inaccessible sites for bacteriological confirmation makes diagnosis of childhood tuberculosis difficult. Circumstantial evidence is often the basis of diagnosis. However, as clinical manifestations depend upon host immune response and virulence of tubercle bacilli, there is no typical clinical presentation. A large number of infected children may remain asymptomatic, undiagnosed and untreated. Conventional tests such as tuberculin test and radiology are not fully dependable and newer tests have limitations. Poor patient treatment compliance contributes to failure of a tuberculosis control program and leads to drug resistance. To combat this, direct observed treatment (DOTS) has been unanimously recommended in treatment of tuberculosis. DOTS is however estimated to be used in less than 40% of new cases. Misconceptions threaten to undermine continued success in tuberculosis control. TB control is essentially a management problem. Greater accountability of governments, donors and providers is essential.