Cavitating pulmonary tuberculosis below age of 2 years.

A prospective study was conducted on 75 consecutive cases of primary cavitary pulmonary tuberculosis in hospitalized children below 2 years to determine the spectrum of the disease. Diagnosis was based on clinical, radiological, tuberculin test and histopathological findings and not on isolation of tubercle bacilli. Peak age was 7-12 months. Ten mothers suffered from pulmonary fibrocavitary disease and 73% of cases were severely malnourished. Presenting symptoms were fever and cough, at times dyspnea and often followed measles. Unlike adults, hemoptysis was seldom encountered. Cavitary lesions were characterized by protean radiological manifestations and varied in size and appearance. They were more often multiple than solitary, bilateral or distributed in one or more lobes, usually in the right lung. Location within consolidation and other associated pulmonary pathology was frequent with miliary nodules in 45.3%. Widespread hematogenous infection was common with tuberculous meningitis in 28%. The accepted diagnostic features of tuberculosis, viz., hilar and mediastinal lymhadenopathy and positive tuberculin test were often absent. Mortality was 34.7% and in inverse proportion to age. The observations stress the difficulties in diagnosis [corrected].

Prevention of tuberculosis in infancy.

A prospective study was conducted on 185 consecutive hospitalized cases of tuberculosis below the age of one year, and 41 mothers comprised half of the 83 contacts detected. Maternal and infant infection was analyzed to determine whether the disease could have been prevented under the existing medico-socio-economic conditions. Most mothers had delayed diagnosis and extensive disease. Earlier imperfect courses of chemotherapy were not uncommon. Ten mothers were sputum-positive for acid-fast bacilli. The concerned medical personnel failed to give proper advice with respect to chemoprophylaxis and surveillance of infants. Majority of infants had progressive pulmonary and disseminated disease although, 41% of them were BCG vaccinated. A practical strategy in the Indian context for the management of tuberculosis in the mother-infant pair is outlined.