TB Management in Children: Diagnosis and Signs
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Session 10b: TB Management:
Children
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By the end of this session participants should be
able to:
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Describe the signs and symptom of TB in children
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Demonstrate effective clinical application of
algorithms for TB diagnosis in children
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Explain the management of TB in children
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Demonstrate accurate recording and reporting,
using correct tools
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TB diagnosis in children based on combination of;
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history of exposure
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clinical presentation
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TST test and
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chest x-ray
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History of exposure, especially to a close
family member
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Most common symptoms are:
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Chronic cough = cough >14 days, not improving
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Fever of greater > 38 degrees C every day for 14
days, after excluding common causes
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Documented weight loss / Failure to thrive
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Unusual fatigue in child - not playing or very tired
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Signs suggestive of TB disease:
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Fever > 38 degrees C every day for 2 weeks, after
excluding common causes
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Painless enlarged lymph nodes (usually in neck)
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Night sweats
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Breathlessness
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Peripheral Oedema
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Painful limbs and joints
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Headache, irritability, drowsiness, neck stiffness
and convulsions
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Meningitis not responding to treatment
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Big liver and spleen
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Distended abdomen with ascites
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Breathlessness and peripheral oedema
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Severe wheezing not responding to
bronchodilators
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Acute onset of bending of the spine
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Exposure to smear or culture positive case of
PTB
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Indication of TB infection
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TST 10mm or more in HIV-negative or 5mm or
more in HIV positive children
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Symptoms suggestive of TB
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Screen HIV positive children for TB exposure
and symptoms at each clinical visit
Note: Whenever possible encourage child to
produce sputum for diagnostic confirmation.
Preferred method via gastric aspirate or
induction. Xpert can be used on gastric/lymph
node aspirate, pleural fluid, cerebrospinal fluid,
or biopsies
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Screen all children in close contact with an
infectious case of TB to exclude TB disease
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Screening should include:
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thorough history
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clinical exam
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Children with symptoms require TST test and
chest x-ray, if available, to aid diagnosis
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Rapidly identify and screen close child contacts
of MDR-TB cases
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Also, ideally, refer to expert MDR centre in Province
for evaluation
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Asymptomatic contacts should receive 6-monthly
(HIV negative) or 3-monthly (HIV-positive) clinical
follow-up for at least two years
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If active MDR-TB develops, promptly initiate
regimen of treatment designed to treat MDR-TB
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Signs and symptoms of TB and those of other
HIV related lung diseases could look the same
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TST skin test is frequently negative even
though child may have TB
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Radiological features of TB are usually similar
to those in HIV-negative children, but picture
could be atypical
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Differential diagnosis of
pulmonary TB in HIV-
infected children
includes:
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bacterial pneumonia
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viral pneumonia
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fungal lung disease
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pneumocystis jiroveci
pneumonia
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pulmonary lymphoma
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Kaposi’s sarcoma
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If there is uncertainty of
TB diagnosis, treat child
with antibiotics for 5-7
days and repeat chest
x-ray after two weeks
depending on clinical
picture
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Refer to page 156 of your participant manual to
see the algorithm
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Congenital TB is rare!
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Baby should not receive BCG at birth
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If baby is symptomatic:
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Refer to hospital for evaluation to exclude TB
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If baby has TB, give baby full course of TB
treatment (regimen 3)
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Start TB treatment in a referral centre to ensure
correct dosages
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If baby is asymptomatic:
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Baby needs preventive therapy (isoniazid 10
mg/kg/day) for 6 months
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Baby should not initially receive BCG vaccination
since IPT or TB treatment will kill vaccine
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If baby continues to be asymptomatic, administer
BCG after completion of preventive treatment
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unless child is HIV infected or has symptoms
suggestive of HIV
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Exclude HIV infection
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Refer HIV-infected children for HIV/ART services
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Counsel mother about importance of a balanced diet
and healthy eating
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Consider referral for nutritional support
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Documentation:
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Complete TB Register
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Make a note in Road to Health Booklet (RtHB)
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Record weight at each monthly visit in RtHB
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Ask about other children or adults in household, screen
them for TB
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HIV test - important to diagnose childhood TB
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In children < 18 months:
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Screen for HIV with HIV DNA PCR test
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Confirm HIV with Viral Load (HIV RNA) test
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In children > 18 months
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Use HIV ELISA or HIV rapid test to screen and
confirm diagnosis
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Diagnosis of TB in HIV-infected children is the
same as for HIV-uninfected children except
there is greater uncertainty because:
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TB symptoms can be confused with HIV
symptoms
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Chest x-ray is more difficult to interpret
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Where TB contact has been identified and
once active TB disease has been excluded,
these children should receive 6 months of INH
preventive therapy (IPT):
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All children under 5 (including neonates)
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All HIV-infected children, irrespective of age
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Pre-exposure IPT is not recommended for any
child irrespective of HIV status
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Repeat IPT with each new exposure to
infectious TB, as previous IPT or TB treatment
does not protect against future TB
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If re-exposure to infectious TB case occurs while
on IPT, continue IPT as long as source case
remains infectious
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Exclude active TB prior to IPT – if any of these
signs/symptoms exist, investigate for TB and
do NOT start IPT:
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Cough or wheeze > 2 weeks, not improving on
treatment
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Persistent fever of > 2 weeks
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Documented weight loss/ failure to thrive
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Fatigue (less playful/ always tired)
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If any of the above is present, investigate for TB
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Screen all children for TB at every visit. This should include:
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Asking about TB contacts
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Contact with a TB infected person within the last 12 months
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Asking about TB symptoms
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Cough / fever / loss of weight / night sweats
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If positive TB contact and no active disease
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offer IPT for 6 months
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In all children <5 years
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In all HIV-positive children up to 15 years
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Dose 10mg/kg of INH with pyridoxine for 6 months
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Repeat with every TB exposure
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Refer to page 159 of your participant manual
to see the IPT dosage chart
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If unable to swallow tablet or fraction of tablet,
advise caregivers to crush medicine and
dissolve it in water or multi-vitamin syrup
before giving it to child
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If HIV-infected or malnourished, provide
pyridoxine daily for 6 months:
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If < 5 years of age: 12.5mg daily
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If > 5 years of age: 25mg daily
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This Photo
by Unknown Author is licensed under
CC BY-SA
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Before effective anti-TB chemotherapy, TB
meningitis was uniformly fatal
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TB meningitis remains potentially devastating,
associated with high morbidity and mortality
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HIV positive clients - increased risk for
developing TB meningitis but clinical features
and outcomes similar to that in HIV-negative
clients
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Gradual onset of headache, malaise,
confusion, decreased consciousness and
sometimes vomiting
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Examination reveals neck stiffness and a
positive Kernig's sign
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Diagnosis rests on clinical presentation &
lumbar puncture exam of cerebrospinal fluid
(CSF)
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Refer clients with suspected TB meningitis to
hospital without delay
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TB meningitis is life threatening, with serious
complications if not treated promptly
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Clients with severe neurological impairment such
as drowsiness or coma are at greater risk of
neurological sequelae and higher mortality
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Refer to page 164 of your participant manual
to see the CSF Differential Diagnosis chart
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Results from widespread blood borne
dissemination of TB bacilli
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Consequence of:
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a recent primary infection or
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erosion of a TB lesion into a blood vessel
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Occurs most often in children and young
adults
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Highly fatal
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General deterioration in
health and symptoms
such as:
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high fever
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night sweats
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weight loss
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shortness of breath
Clinical signs may reflect
involvement of other
organs:
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pleural effusion
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digestive problems
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Hepatosplenomegaly
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meningeal signs
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Chest X-ray
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Full blood count
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Liver function tests which may be abnormal
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Bacteriological confirmation sometimes
possible from sputum, CSF, or bone marrow
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Xpert/smear microscopy of sputum may be
negative, as disease is paucibacillary
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Caused by lymphatic spread of organism
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Very common form of extra-pulmonary TB
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Involvement of lymph nodes is usually a
complication of primary TB
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More common in children
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Tends to be found in later stages of HIV
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Large mediastinal lymph nodes can compress
airways leading to an audible wheeze or typical
brassy cough
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Peripheral TB lymphadenopathy most commonly
occurs in neck and armpits
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Typically, lymph nodes are large (>2 cm), tender, non-
symmetrical, matted, firm to fluctuant and rapidly
growing
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Associated systemic features include: fever, night
sweats and weight loss
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As nodes increase in size and become fluctuant,
may suppurate and drain via a chronic fistula,
resulting ultimately in scarring
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Differentiate TB lymphadenopathy from persistent
generalized lymphadenopathy (PGL)
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TB infected lymph nodes decrease very slowly in
size (over weeks or months) on treatment
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in a few cases, still same size after treatment
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Does not mean was not successful
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If lymph node is exuding caseous material
through a fistula, send to lab for microscopy
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Otherwise, refer client for a needle aspirate of
lymph node
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Refer to page 166 of your participant manual
to see the Diagnostic Algorithm for TB
Lymphadenitis
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May occur in any serous cavity of the body,
i.e. pleural, pericardial or peritoneal cavities
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Common form of TB in HIV positive clients
with systemic and local features
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TB culture of no immediate help because
culture result takes six weeks or more
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Most common cause of a unilateral pleural
effusion in countries with a high TB burden
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Also most common form of HIV-related extra-
pulmonary disease
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mortality of about 20% in first 2 months on
treatment
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Management of TB pleural effusion
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start TB treatment promptly and determining HIV-
status of client
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Acute presentation:
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non-productive cough
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chest pain
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shortness of breath
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high temperature
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Chronic form found
predominantly in elderly
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Presents with:
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Weakness
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Anorexia
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weight loss
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slight fever
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cough
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chest pain
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Clinical examination shows:
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Tracheal and mediastinal shift away from the side
of the effusion
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Decreased chest movement
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Stony dullness on percussion on side of effusion
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Confirm suspected pleural effusions by immediate chest x-
ray
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This will show unilateral, uniform white opacity, often
with a concave upper border
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Refer for pleural aspiration wherever possible
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Xpert may be requested on pleural fluid or pleural biopsies
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If aspiration is not possible, TB treatment will be started
unless chest x-ray suggests a different diagnosis
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Tuberculosis accounts for about:
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90% of pericardial effusions in HIV positive clients
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50% of those who are HIV-negative
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Cardiovascular
symptoms include:
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chest pain
–
shortness of breath
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cough
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dizziness
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weakness due to low
cardiac output.
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Symptoms of right-sided
heart failure include:
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leg swelling
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right hypochondrial pain
(liver congestion)
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abdominal swelling
(ascites)
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Signs include:
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Tachycardia
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low blood pressure
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pulsus paradoxus
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raised jugular venous
pressure
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impalpable apex beat
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distant heart sounds
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a pericardial friction rub
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Signs of right-sided
heart failure include:
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hepatosplenomegaly
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ascites
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peripheral oedema
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f
f
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D
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n
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s
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Usually rests on suggestive systemic features
and ultrasound where available. Refer client with
signs of pericardial effusion for diagnostic testing.
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Chest X-ray may show a large globular heart, clear
lung fields and bilateral pleural effusions
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ECG may show tachycardia, flattening of ST and T
waves, low voltage QRS complexes
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TB is most likely cause and treatment is the same
for all types of TB
P
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T
u
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Most common type of abdominal TB
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C
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n
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c
a
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F
e
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t
u
r
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Systemic features and ascites with no signs of
portal hypertension
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There may be palpable abdominal masses
(mesenteric lymph nodes)
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Bowel obstruction may develop from adhesion
of caseous nodules to bowel
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D
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Refer for a diagnostic ascitic tap and
abdominal ultrasound if available
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Xpert can be used on aspirated ascitic fluid
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Investigate for pulmonary TB
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c
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m
p
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a
(
1
)
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Usually arises when a TB cavity in lung
ruptures into pleural space
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Physical signs are similar to a pleural effusion
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Succussion splash = splashing sound heard
with stethoscope while shaking client's chest
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Indicates a pyopneumothorax (pus and air in
pleural space)
T
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)
•
TB can affect any bone but most commonly affects
vertebral column
•
Seen both in children and adults and can be severe,
with neurological sequelae
•
In children, acute form with vertebral osteomyelitis and
collapse of vertebral body
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Involvement of intervertebral disc occurs by spread of
a lesion from vertebral body
•
In many cases > one intervertebral disc is involved
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Characterised by loss of bone density and slow bone
erosion, with disc space being maintained for a long
time
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Physical exam in early stages may be non-specific
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Back pain, stiff back, reluctance to bend the back
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May be referred pain radiating out from site of origin
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Localised swelling, sometimes with an obvious lump or
abnormal curvature of spine
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Involvement of cervical vertebrae may cause pain in
neck and shoulders and rigidity of neck
•
Refer urgently, a child that refuses to walk or has
weakness or paralysis of the lower limbs
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D
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a
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X-rays of spine
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Biopsy of cold abscess for Xpert/microscopy
and culture if possible, can confirm diagnosis
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Differential diagnosis includes:
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degenerative disc disease
•
infectious spondylitis
•
cancerous vertebral metastases
P
r
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t
m
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f
o
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E
P
T
B
•
Same treatment principles as for PTB:
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Regimen 1 for new cases
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If DR-TB, treat as indicated for resistance
•
A specialist may decide to extend treatment of severe
forms of EPTB from 6 to 9 months and to provide
corticosteroids
•
Intensive phase remains two months and continuation
phase is prolonged to seven months – 2(RHZE)/7(HR)
•
Assess response to treatment clinically
•
Weight loss may occur as large effusions / ascites
resolve and does not necessarily indicate failure to
respond
A
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y
Q
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s
t
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s
?
Thank you!
This session covers essential aspects of diagnosing and managing Tuberculosis (TB) in children. Participants will learn about the signs and symptoms of TB, diagnostic methods, management strategies, and the importance of accurate reporting. Key topics include history of exposure, clinical presentation, TB diagnosis algorithms, and indications for evaluating children as TB suspects. Additionally, the session highlights danger signs that require urgent referral for children with TB.
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Presentation Transcript
Basic HIV Course for Health Professionals Session 10b: TB Management: Children
Learning Objectives By the end of this session participants should be able to: Describe the signs and symptom of TB in children Demonstrate effective clinical application of algorithms for TB diagnosis in children Explain the management of TB in children Demonstrate accurate recording and reporting, using correct tools
Diagnosing TB in Children TB diagnosis in children based on combination of; history of exposure clinical presentation TST test and chest x-ray
Signs and Symptoms of TB Disease in Children (1) History of exposure, especially to a close family member Most common symptoms are: Chronic cough = cough >14 days, not improving Fever of greater > 38 degrees C every day for 14 days, after excluding common causes Documented weight loss / Failure to thrive Unusual fatigue in child - not playing or very tired
Signs and Symptoms of TB Disease in Children (2) Signs suggestive of TB disease: Fever > 38 degrees C every day for 2 weeks, after excluding common causes Painless enlarged lymph nodes (usually in neck) Night sweats Breathlessness Peripheral Oedema Painful limbs and joints
Danger Signs of TB in Children Requiring Urgent Referral Headache, irritability, drowsiness, neck stiffness and convulsions Meningitis not responding to treatment Big liver and spleen Distended abdomen with ascites Breathlessness and peripheral oedema Severe wheezing not responding to bronchodilators Acute onset of bending of the spine
Indications for the Evaluation of Children as TB Suspects Exposure to smear or culture positive case of PTB Indication of TB infection TST 10mm or more in HIV-negative or 5mm or more in HIV positive children Symptoms suggestive of TB Screen HIV positive children for TB exposure and symptoms at each clinical visit
REGARD AS TB CASE IF THE FOLLOWING EXIST There are symptoms of TB (e.g. increased temperature for 3 weeks, progressive weight loss on the road to health chart) AND An abnormal chest x-ray suggestive of TB SCENARIO History of exposure to infectious TB case WITH Confirmed infection (positive TST) History of exposure to infectious TB case OR Confirmed infection (positive TST) AND An abnormal chest x-ray suggestive of TB The diagnosis can be confirmed by collecting a gastric aspirate or sputum for Xpert/smear and culture. Symptoms of TB Symptoms of TB AND History of exposure to infectious TB case OR Confirmed infection (positive TST) No Chest X-ray available
Note: Whenever possible encourage child to produce sputum for diagnostic confirmation. Preferred method via gastric aspirate or induction. Xpert can be used on gastric/lymph node aspirate, pleural fluid, cerebrospinal fluid, or biopsies
Contact Screening (1) Screen all children in close contact with an infectious case of TB to exclude TB disease Screening should include: thorough history clinical exam Children with symptoms require TST test and chest x-ray, if available, to aid diagnosis
Contact Screening (2) Rapidly identify and screen close child contacts of MDR-TB cases Also, ideally, refer to expert MDR centre in Province for evaluation Asymptomatic contacts should receive 6-monthly (HIV negative) or 3-monthly (HIV-positive) clinical follow-up for at least two years If active MDR-TB develops, promptly initiate regimen of treatment designed to treat MDR-TB
Diagnosing TB in HIV-infected Children (1) Signs and symptoms of TB and those of other HIV related lung diseases could look the same TST skin test is frequently negative even though child may have TB Radiological features of TB are usually similar to those in HIV-negative children, but picture could be atypical
Diagnosing TB in HIV-infected Children (2) Differential diagnosis of pulmonary TB in HIV- infected children includes: bacterial pneumonia viral pneumonia fungal lung disease pneumocystis jiroveci pneumonia pulmonary lymphoma Kaposi s sarcoma If there is uncertainty of TB diagnosis, treat child with antibiotics for 5-7 days and repeat chest x-ray after two weeks depending on clinical picture
Algorithm for Screening a Child with Documented TB Exposure Refer to page 156 of your participant manual to see the algorithm
Infants Exposed to TB Disease (1) Congenital TB is rare! Baby should not receive BCG at birth If baby is symptomatic: Refer to hospital for evaluation to exclude TB If baby has TB, give baby full course of TB treatment (regimen 3) Start TB treatment in a referral centre to ensure correct dosages
Infants Exposed to TB Disease (2) If baby is asymptomatic: Baby needs preventive therapy (isoniazid 10 mg/kg/day) for 6 months Baby should not initially receive BCG vaccination since IPT or TB treatment will kill vaccine If baby continues to be asymptomatic, administer BCG after completion of preventive treatment unless child is HIV infected or has symptoms suggestive of HIV
How to Treat Neonates of Mothers with TB
Next Steps for a Child Diagnosed with TB Exclude HIV infection Refer HIV-infected children for HIV/ART services Counsel mother about importance of a balanced diet and healthy eating Consider referral for nutritional support Documentation: Complete TB Register Make a note in Road to Health Booklet (RtHB) Record weight at each monthly visit in RtHB Ask about other children or adults in household, screen them for TB
HIV Testing in Childhood TB Suspects (1) HIV test - important to diagnose childhood TB In children < 18 months: Screen for HIV with HIV DNA PCR test Confirm HIV with Viral Load (HIV RNA) test In children > 18 months Use HIV ELISA or HIV rapid test to screen and confirm diagnosis
HIV Testing in Childhood TB Suspects (2) Diagnosis of TB in HIV-infected children is the same as for HIV-uninfected children except there is greater uncertainty because: TB symptoms can be confused with HIV symptoms Chest x-ray is more difficult to interpret
INH Prophylaxis in Children (1) Where TB contact has been identified and once active TB disease has been excluded, these children should receive 6 months of INH preventive therapy (IPT): All children under 5 (including neonates) All HIV-infected children, irrespective of age
INH Prophylaxis in Children (2) Pre-exposure IPT is not recommended for any child irrespective of HIV status Repeat IPT with each new exposure to infectious TB, as previous IPT or TB treatment does not protect against future TB If re-exposure to infectious TB case occurs while on IPT, continue IPT as long as source case remains infectious
INH Prophylaxis in Children (3) Exclude active TB prior to IPT if any of these signs/symptoms exist, investigate for TB and do NOT start IPT: Cough or wheeze > 2 weeks, not improving on treatment Persistent fever of > 2 weeks Documented weight loss/ failure to thrive Fatigue (less playful/ always tired) If any of the above is present, investigate for TB
IPT and children Screen all children for TB at every visit. This should include: Asking about TB contacts Contact with a TB infected person within the last 12 months Asking about TB symptoms Cough / fever / loss of weight / night sweats If positive TB contact and no active disease then offer IPT for 6 months In all children <5 years In all HIV-positive children up to 15 years Dose 10mg/kg of INH with pyridoxine for 6 months Repeat with every TB exposure
Recommended IPT Dosage for Children Refer to page 159 of your participant manual to see the IPT dosage chart
Tips on IPT for Children If unable to swallow tablet or fraction of tablet, advise caregivers to crush medicine and dissolve it in water or multi-vitamin syrup before giving it to child If HIV-infected or malnourished, provide pyridoxine daily for 6 months: If < 5 years of age: 12.5mg daily If > 5 years of age: 25mg daily
TB Meningitis Before effective anti-TB chemotherapy, TB meningitis was uniformly fatal TB meningitis remains potentially devastating, associated with high morbidity and mortality HIV positive clients - increased risk for developing TB meningitis but clinical features and outcomes similar to that in HIV-negative clients
TB Meningitis: Clinical Presentation and Management (1) Gradual onset of headache, malaise, confusion, decreased consciousness and sometimes vomiting Examination reveals neck stiffness and a positive Kernig's sign
TB Meningitis: Clinical Presentation and Management (2) Diagnosis rests on clinical presentation & lumbar puncture exam of cerebrospinal fluid (CSF) Refer clients with suspected TB meningitis to hospital without delay TB meningitis is life threatening, with serious complications if not treated promptly Clients with severe neurological impairment such as drowsiness or coma are at greater risk of neurological sequelae and higher mortality
CSF Differential Diagnosis for TB Meningitis Refer to page 164 of your participant manual to see the CSF Differential Diagnosis chart
Disseminated / Miliary TB Results from widespread blood borne dissemination of TB bacilli Consequence of: a recent primary infection or erosion of a TB lesion into a blood vessel Occurs most often in children and young adults Highly fatal
When disseminated TB is suspected, treatment should be commenced immediately without waiting for bacteriological proof of diagnosis.
Disseminated TB: Clinical Features (1) General deterioration in health and symptoms such as: high fever night sweats weight loss shortness of breath Clinical signs may reflect involvement of other organs: pleural effusion digestive problems Hepatosplenomegaly meningeal signs
Disseminated TB: Diagnosis Chest X-ray Full blood count Liver function tests which may be abnormal Bacteriological confirmation sometimes possible from sputum, CSF, or bone marrow Xpert/smear microscopy of sputum may be negative, as disease is paucibacillary
Tuberculous Lymphadenopathy Caused by lymphatic spread of organism Very common form of extra-pulmonary TB Involvement of lymph nodes is usually a complication of primary TB More common in children Tends to be found in later stages of HIV
Tuberculous Lymphadenopathy: Clinical Features (1) Large mediastinal lymph nodes can compress airways leading to an audible wheeze or typical brassy cough Peripheral TB lymphadenopathy most commonly occurs in neck and armpits Typically, lymph nodes are large (>2 cm), tender, non- symmetrical, matted, firm to fluctuant and rapidly growing Associated systemic features include: fever, night sweats and weight loss
Tuberculous Lymphadenopathy: Clinical Features (2) As nodes increase in size and become fluctuant, may suppurate and drain via a chronic fistula, resulting ultimately in scarring Differentiate TB lymphadenopathy from persistent generalized lymphadenopathy (PGL) TB infected lymph nodes decrease very slowly in size (over weeks or months) on treatment in a few cases, still same size after treatment Does not mean was not successful
Tuberculous Lymphadenopathy: Diagnosis If lymph node is exuding caseous material through a fistula, send to lab for microscopy Otherwise, refer client for a needle aspirate of lymph node Refer to page 166 of your participant manual to see the Diagnostic Algorithm for TB Lymphadenitis
Tuberculous Serous Effusions May occur in any serous cavity of the body, i.e. pleural, pericardial or peritoneal cavities Common form of TB in HIV positive clients with systemic and local features TB culture of no immediate help because culture result takes six weeks or more
Tuberculous Pleural Effusion Most common cause of a unilateral pleural effusion in countries with a high TB burden Also most common form of HIV-related extra- pulmonary disease mortality of about 20% in first 2 months on treatment Management of TB pleural effusion start TB treatment promptly and determining HIV- status of client
TB Pleural Effusion: Clinical Features (1) Acute presentation: non-productive cough chest pain shortness of breath high temperature Chronic form found predominantly in elderly Presents with: Weakness Anorexia weight loss slight fever cough chest pain
TB Pleural Effusion: Clinical Features (2) Clinical examination shows: Tracheal and mediastinal shift away from the side of the effusion Decreased chest movement Stony dullness on percussion on side of effusion
TB Pleural Effusion: Diagnosis Confirm suspected pleural effusions by immediate chest x- ray This will show unilateral, uniform white opacity, often with a concave upper border Refer for pleural aspiration wherever possible Xpert may be requested on pleural fluid or pleural biopsies If aspiration is not possible, TB treatment will be started unless chest x-ray suggests a different diagnosis
Tuberculous Pericardial Effusion Tuberculosis accounts for about: 90% of pericardial effusions in HIV positive clients 50% of those who are HIV-negative
TB Pericardial Effusion: Clinical Features (1) Cardiovascular symptoms include: chest pain shortness of breath cough dizziness weakness due to low cardiac output. Symptoms of right-sided heart failure include: leg swelling right hypochondrial pain (liver congestion) abdominal swelling (ascites)
TB Pericardial Effusion: Clinical Features (2) Signs include: Tachycardia low blood pressure pulsus paradoxus raised jugular venous pressure impalpable apex beat distant heart sounds a pericardial friction rub Signs of right-sided heart failure include: hepatosplenomegaly ascites peripheral oedema
TB Pericardial Effusion: Diagnosis Usually rests on suggestive systemic features and ultrasound where available. Refer client with signs of pericardial effusion for diagnostic testing. Chest X-ray may show a large globular heart, clear lung fields and bilateral pleural effusions ECG may show tachycardia, flattening of ST and T waves, low voltage QRS complexes TB is most likely cause and treatment is the same for all types of TB
Peritoneal Tuberculosis Most common type of abdominal TB
