Tuberculosis infection and disease in children.

Children with primary tuberculosis are more likely than adults to be asymptomatic and to have extrapulmonary disease. If tuberculosis infection or disease is suspected in a child, it is imperative to obtain a detailed medical, family and social history, which must include an investigation of the child's contact with an infectious adult. Because it is difficult to isolate a Mycobacterium tuberculosis strain from children, the treatment regimen must often be based on the susceptibility pattern of the M. tuberculosis strain in the infecting adult. Patients with fully susceptible pulmonary tuberculosis are treated with isoniazid, rifampin and pyrazinamide for two months and then with isoniazid and rifampin for four more months. If infection with a drug-resistant organism is suspected, other medications should be used for treatment. When treating a child with possible tuberculosis disease, the primary care physician generally should consult with a pediatric tuberculosis specialist. Identifying the adult source of a child's tuberculous infection and marshalling the resources needed for treatment are best done in conjunction with the local health department.