Symptoms

Descriptor

Exclusions

Specific Comments

TB Lymphadenitis

Superficial Lymph nodes are
considered significant if:
1. Inguinal Lymph nodes > 1.5 cm
2. Cervical & axilliary Lymph nodes
> 1cm
3. Matted Lymph nodes
4. Generalized Lymphadenopathy
5. Failure to respond to antibiotic
therapy for 2 weeks
Isolated left axillary lymphadeno-
pathy in an infant

Posterior Cervical Lymphadeno-
pathy is almost always not due to
TB

Histopathological diagnosis is a must
FNAC is procedure of choice
FNAC has good sensitivity & specificity

Biopsy is rarely required.
Aspirate must be stained for AFB/
Highly suggestive of TB in presence of other
supportive features.


Due to BCG. Does not require treatment even if 
histopathology or bacteriology is positive

Abdominal TB

Clinical presentations include Ascitis,
subacute obstruction or pyrexia of 
unknown origin with or without hepato-
splenomegaly

Small lymphnodes or mild 
ascitis on USG may not be
significant

Abdominal USG shows the presence of significant
Lymph nodes or peritoneal fluid
Barium meal follow through showing pulled up
caecum is highly suggestive of TB
Serum albumin ascitic fluid gradient < 1.1 highly 
suggestive of TB

Neurotuberculosis
TB Meningitis

Early diagnosis in Stage 1 is suggested
by:
1. Fever without localization for more
than 2 weeks and/or
2. Altered behavior / change in personality
of recent origin
3. Headache, vomiting suggestive of raised
ICT
4. Movement disorder
5. Focal deficits
6. Seizures

Global encephalopathy with focal deficits is highly
suggestive of TBM
CSF examination is a must
In case of inconclusive results, repeat examination 
is necessary after antibiotic trial for 3-4 days
CSF glucose must be interpretd in conjunction with
blood glucose
CSF smear & culture are negative in 90% of the 
cases
CSF antigen tests are useful but not ciurrently
available
CSF ADA may suggest diagnosis
CSF PCR is variable
Mantoux test is negative in 70% of the cases.
CT Scan shows basal exudates & hydrocephalus 
in 80-100% of the patients and is a useful diagnostic
modality. Normal CT Scan does not rule out TBM

Tuberculoma

Features to differentiate tuberculoma
from NCC
1. Tuberculomas are larger
2. Tuberculomas are ususally multiple
3. Tuberculomas are more common in
the posterior fossa while NCC are
 present in the gray-white junction

Differentiating Tuberculomas from NCC is 
difficult
MR spectoscropy shows lipid peaks in tuberculoma 
Costly, not easily available and not recommended.

HIV & TB

In HIV positive but immunocompetent
patient the manifestations of TB are
In HIV positive immunocompromized
patient the manifestations of TB are 
florid, drug reactions are common &
therapeutiv paradox is known 
Mantoux test of 5mm of reaction is 
considered significant although it is 
often negative
Pathagnomic X-ray features are:
1. Confluent patchy consolidations 
involving more than half lung
2. Dense lobar / segmental collapse
3. Massive paratracheal / Hilar 
lymphadenopathy
4. Concomitant Bronchiectasis

Management of HIV with TB needs specialized 
expertise & hence referal to tertiary center is
recommended.

MDR TB

MDR TB considered when:
1. Child has contact with MDR TB
2. Failure of response to adequate
treatment for 8-12 weeks

MDR TB is rare in in children
Before considering diagnosis of MDR TB, consider
reviewing diagnosis of TB itself.

MDR TB must be confirmed by bacteriology
Ideally patient must be refered to a referral center 
for further management