TUBERCULOSIS IN CHILDREN, ADOLESCENTS AND ADULTS: A PUBLIC HEALTH EDUCATION ARTICLE

By Dr. Weriwoyingipre Silver Yeibake

Paediatrics, Federal Medical Centre, Yenagoa  

silveryeibake@gmail.com

Tuberculosis (TB) is a serious but preventable and curable infectious disease caused by _Mycobacterium tuberculosis_ [1]. It spreads through the air when a person with active TB coughs, sneezes, speaks, or spits, so early diagnosis and treatment are essential to protect families and communities [1]. TB remains a major public health problem, and in many settings it is closely linked with poverty, poor health-seeking behaviour, and limited awareness of symptoms and treatment [1][2].

Understanding TB

TB most commonly affects the lungs, but it can also affect the brain, bones, kidneys, spine, and other organs [1]. *Latent TB infection* means the person has TB germs in the body but no symptoms and cannot spread the disease to others, while *active TB disease* means the germs are multiplying, symptoms are present, and the person may spread infection if the lungs or throat are involved [1]. After infection, some people develop active disease soon afterwards, some remain well for many years until the infection becomes active, and others may never develop disease at all [1][3]. However, a substantial number of infected people do progress to disease, especially when risk factors are present [1][2].

How TB Is Acquired

TB is acquired when a person inhales tiny airborne droplets containing TB germs released by someone with active pulmonary TB [1]. Close, repeated contact in crowded or poorly ventilated spaces increases the chance of infection [1]. Keeping windows closed in poorly ventilated houses, spending time in crowded venues, and travelling in crowded vehicles also increase the risk of transmission [1][2]. TB is not usually spread by sharing food, shaking hands, or touching surfaces [1]. In children, infection usually comes from close household contact with an infectious adult, especially a parent or caregiver [3].

What Reactivates Latent TB

Latent TB may become active when the body’s defences are weakened [1]. Important activators include weakened immunity from coexisting diseases, misuse or abuse of certain drugs, certain cancers, and malnutrition [1][2].

Specific conditions and agents associated with activation include:

- HIV infection.

- Diabetes mellitus.

- Chronic kidney disease.

- Silicosis.

- Cancer, especially lymphoma and leukaemia.

- Drugs that suppress immunity, such as corticosteroids and chemotherapy agents.

- Biologic immune-modifying drugs, especially anti-TNF agents such as infliximab, adalimumab, and etanercept.

- Other immunosuppressants such as methotrexate, azathioprine, ciclosporin, tacrolimus, and mycophenolate.

- Severe malnutrition and undernutrition.

- Substance misuse that weakens health and nutrition, including harmful alcohol use and smoking.

Symptoms To Watch For

TB should be suspected in anyone with a cough lasting more than two weeks, especially when accompanied by drenching night sweats, persistent fever, weight loss, chest pain, fatigue, or loss of appetite [1]. In infants and young children, symptoms may be less specific and can include poor weight gain, reduced playfulness, lethargy, fever, and persistent cough [3]. Because symptoms can start gradually, people often dismiss them at first [1]. Any cough that does not improve, particularly with fever and night sweats, should be evaluated promptly [1].

Risk Factors

Some people are more likely to develop TB than others. Important risk factors include close contact with someone who has active TB, HIV infection, diabetes, malnutrition, tobacco use, alcohol use, crowded living conditions, and poor ventilation [1][2]. Babies, infants, and young children are especially vulnerable, and children under 5 years are at higher risk of severe disease if infected [1][3]. People living or working in high-risk settings such as prisons, shelters, and health facilities are also at increased risk [1][2]. Because TB risk is higher in these groups, early screening and timely care matter [1].

How TB Is Diagnosed

TB diagnosis starts with careful history and examination, because symptoms may be vague or absent early on [1]. In adults and adolescents, diagnosis often depends on sputum-based molecular testing, chest imaging, and clinical assessment [1]. Where available, rapid diagnostic tests are recommended as the initial tests in people with signs and symptoms of TB [1]. If a patient has compatible symptoms or a positive screening result, further diagnostic evaluation is required rather than relying on screening alone [1]. In children, WHO-endorsed treatment decision algorithms can support diagnosis when bacteriological confirmation is difficult, but they do not replace clinical judgement [4].

How Childhood TB Is Managed Differently

TB in children is often harder to confirm because they may not produce sputum, and the disease is usually less easy to prove in the laboratory than in adults [5][6]. Diagnosis therefore depends on the whole clinical picture, including exposure history, symptoms, growth pattern, chest X-ray findings, TB infection tests, and microbiological samples such as gastric aspirates or stool when needed [5][6]. A negative smear or culture does not rule out TB in a child [5][6]. WHO guidance supports child- and adolescent-specific approaches, including shorter treatment for some children with non-severe drug-susceptible TB and special regimens for TB meningitis or drug-resistant disease [6][7]. Management is family-centred, weight-based, and often linked with contact tracing and preventive treatment for exposed household members [6][3]. Recent peer-reviewed evidence supports WHO treatment decision algorithms for children with presumptive TB, but they should be used as part of a broader diagnostic pathway rather than as a standalone test [4].

How Adolescent and Adult TB Is Diagnosed and Managed

Adolescents and adults are more likely than young children to provide sputum, so microbiological confirmation is often easier in this group [1]. Diagnosis commonly uses symptom screening, sputum molecular tests, and chest imaging, with extra attention to people living with HIV or other conditions that increase TB risk [1][2]. Management of drug-susceptible TB usually involves a standard combination of medicines for several months, while drug-resistant TB requires specialist-guided regimens and close follow-up [1][2][7]. Support for adherence, adverse-effect monitoring, and treatment of coexisting illnesses such as HIV, diabetes, or malnutrition is essential to good outcomes [1][2].

 Complications

If TB is not treated early, it can cause serious complications [1]. These may include severe lung damage, coughing up blood, pleural effusion, spread of infection to other organs, and long-term breathing problems [1]. TB can also affect the brain, bones, kidneys, and spine, leading to meningitis, paralysis, bone destruction, or organ failure in severe cases [1][5]. In infants and young children, disseminated TB and TB meningitis are more likely and can be life-threatening [5][3]. Delays in recognising and treating TB are a major contributor to complications, including disability and death [1][2]. In people with HIV or other immune problems, TB can become rapidly life-threatening [1][2]. Peer-reviewed evidence also shows that TB can lead to long-term respiratory impairment and disability after treatment [8].

Common Myths About TB

Many false beliefs delay diagnosis and treatment. TB is not caused by cold weather, dust, or inheritance; it is caused by bacteria and usually spreads from person to person through the air [1]. TB is also not a death sentence, because it is curable with proper treatment [1]. A mild cough can still be TB, and traditional remedies alone cannot replace medical treatment [1]. Some herbs, such as garlic, ginger, turmeric, and bitter leaf, are often suggested for general wellness, but none has been shown to alter the outcome of TB disease or cure it [1][2].

Why Myths Matter

Myths create stigma, and stigma keeps people away from testing and treatment [1][2]. When someone hides symptoms because of shame or fear, TB continues spreading within households and communities [1][2]. Public education helps people recognise TB early, support patients, and prevent avoidable deaths [1][2].

Prevention

TB can be prevented through practical steps. Seek testing early for any cough lasting more than two weeks, especially if there is fever or night sweats [1]. Ensure good ventilation in homes, schools, and workplaces, and avoid keeping windows closed in poorly ventilated houses [1][2]. Reduce time spent in crowded venues and crowded vehicles where transmission risk is higher [1][2]. Cover the mouth when coughing or sneezing, and avoid overcrowding where possible [1]. Babies born in high-incidence settings should receive BCG vaccination, and exposed infants and young children may need TB preventive treatment after assessment [6][3]. People diagnosed with TB should complete the full course of treatment, while those at higher risk may need preventive treatment recommended by a health worker [1][6].

Call to Action 

If you, your child, or someone you know has a cough lasting more than two weeks with drenching night sweats or persistent fever, get tested for TB immediately [1]. Early diagnosis saves lives, reduces spread, and helps prevent complications [1]. Delays in seeking care are a major contributor to disability and death from TB [1][2]. TB is treatable, and with timely care and adherence to treatment, recovery is possible [1].

References

1. World Health Organization. Tuberculosis. WHO Fact Sheet. 24 March 2026. Available from: [https://www.who.int/news-room/fact-sheets/detail/tuberculosis](https://www.who.int/news-room/fact-sheets/detail/tuberculosis).  

2. World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. 2022. Available from: [https://www.who.int/publications/i/item/9789240046764](https://www.who.int/publications/i/item/9789240046764).  

3. World Health Organization. WHO operational handbook on tuberculosis: module 5: management of tuberculosis in children and adolescents. 2022. Available from: [https://www.who.int/publications/i/item/9789240046832](https://www.who.int/publications/i/item/9789240046832).  

4. World Health Organization. Ending TB in children and adolescents. 23 March 2024. Available from: [https://www.who.int/activities/ending-tb-in-children-and-adolescents](https://www.who.int/activities/ending-tb-in-children-and-adolescents).  

5. World Health Organization. WHO recommendations and operational guidance for tuberculosis diagnosis and management. Available from: [https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/guidelines/tb-guidelines](https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/guidelines/tb-guidelines).  

6. Olbrich L, Larsson L, Dunbar R, Dodd PJ, Palmer M, Huyen Ton Nu Nguyet M, et al. Diagnostic accuracy of the WHO tuberculosis treatment decision algorithms for children with presumptive tuberculosis: an individual participant data meta-analysis. PLoS Med. 2025;22(11):e1004610. doi:10.1371/journal.pmed.1004610.  

7. World Health Organization. Use of bedaquiline in children and adolescents with multidrug- and rifampicin-resistant tuberculosis: information note; and use of delamanid in children and adolescents with multidrug- and rifampicin-resistant tuberculosis: information note. 2023.  

8. Chiang SS, Murray MB, Kay AW, Dodd PJ. Tuberculosis-associated respiratory impairment and disability in children, adolescents and adults: a protocol for a systematic review and individual participant data meta-analysis. BMJ Open. 2025 Mar 24;15(3):e094118. doi:10.1136/bmjopen-2024-094118.