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Table 5 Summary of differences in tuberculosis between adults and children.

From: Clinical peculiarities of tuberculosis

Category Adults Children
Transmission are frequently contagious because they often have:
- cavitary lesions
- multibacillary disease
- pulmonary tuberculosis
- less circumscribed social networks
- more forceful cough
- productive cough
are infrequently contagious because they often have:
- non-cavitary lesions
- paucibacillary disease
- extrapulmonary tuberculosis
- more circumscribed social networks
- less forceful cough
- non-productive cough
Natural history - risk of progression is 5-10%
- time between primary infection and disease is often long (some years)
- risk of progression is:
45% in infants < 1 year of age;
24% in children 1-5 years of age;
15% in adolescents
- time between primary infection and disease is often short (1-6 months)
Clinical presentation - primary infection is often asymptomatic but symptoms and signs are specific
- principally develop pulmonary TB
- primary infection is asymptomatic but it may rapidly progress to symptomatic TB disease with not specific symptoms and signs
- often develop extrapulmonaryand military TB
Diagnosis - for screening purposes TST or IGRAs are recommended
- detection of M. tuberculosis in sputum smear is achieved in 80% of cases
- chest radiography shows cavitary formations
- in children < 5 years of age only TST is recommended because IGRAs may be unreliable
- in children ˃ 5 years of age and adolescents TST or IGRAs are recommended
- detection in gastric aspirates of M. tuberculosis is achieved in less than 40% of cases
- chest radiography shows unspecific lesions (e.g. hilar or mediastinal lymphadenopathy, bronchopneumonia and pleural fluid collections) or may be normal
Treatment - treatment for latent TB in close contacts should be unnecessary
- toxicity induced by anti-tubercular drugs is most common
- use of second-line anti-tubercular agents is formally approved
- fixed dose drug combinations are available
- treatment for latent TB is always necessary and in close contacts< 5 years it should be started also if TST is negative
- toxicity induced by anti-tubercular drugs is less common (also ethambutol is considered safe in young children)
- use of second-line anti-tubercular agents is not formally approved
- few fixed dose drug combinations are available
  1. TB= tuberculosis; TST= Tuberculin Skin Test; IGRAs = Interferon-gamma Release Assays.