Tuberculosis
by Dr. Ira Shah

Tuberculosis (TB) in children has assumed epidemic proportions in recent times. Multi-drug resistant (MDR) and extensively drug resistant (XDR) TB is now being increasingly reported in children. The treatment of these pa¬tients is prolonged and associated with lot of drug toxicity. Thus manage¬ment of these patients is becoming complex and more specialized.
Advances in diagnostics have led to emergence of new tests such as in¬terferon gamma release assays (IGRA) and also nucleic acid amplifica¬tion tests (NAATs) which help to rule out TB and also make diagnosis of TB rapidly respectively. These nucleic acid tests also help to determine resistance to drugs such as INH and rifampicin early so that treatment for MDR TB can be implemented early as compared to the culture and routine drug susceptibility tests (DST) which may have a turn-around time of 6-8 weeks.
However, in spite of these advances, still diagnosis of TB in children is based on circumstantial evidence such as contact with an adult having open TB, positive mantoux test and a non-resolving pneumonia. This had led to several instances where patients have been started on anti-tuberculous therapy (ATT) where in reality they do not have TB. This book discusses about interpretation of mantoux test and its reliability in detail.
Newer TB drugs are on the horizon. With Bedaquiline being approved for treatment in adults and more drugs in the pipeline, we finally have newer drugs to look forward to after a huge gap of 4 decades where no drug was actually discovered for TB. However till their safety is estab¬lished in children, we still must treat patients with the regular anti TB drugs and also the toxic second line drugs for the time being.
The book is written with the aim of aiding clinicians in management of patients with TB, how to interpret the various tests that are available for TB and also with case based approach so that it’s easy to put this knowledge in practical use. After having started seeing patients with TB in a specialized clinic from 2007 and having treated more than 2000 children till date, I hope the knowledge shared in this book will be extremely useful to the reader.