A child's TST (or PPD) result reveals induration which is 12 mm.
HOW WILL YOU PROCEED?
Most likely diagnosis: recent converter of TB?
Management:
chest x-ray (CXR) should be obtained.
1. Positive TST and negative CXR suggest latent tuberculosis infection:
a. Isoniazid – susceptible: 9 months of IN H (isoniazid) once a day
b. Isoniazid – resistant: 6 months of rifampin (RIF) once a day or 9 month of RIF therapy.
c. Isoniazid – rifam pin resistant: consult a TB specialist
2. Positive TST and positive CXR suggest pulmonary TB:
a. 6 months regimens: INH and RIF supplemented with PZA (pyrazinamide) in first 2 months (10 0 % success rate) .
b. 9 months regimens (for hilar adenopathy only): INH and RIF once a day
c. Extrapulmonary (e.g., meningitis, military, bone or joint disease) TB: 2 months of INH, RIF, PZA, and streptomycin once a day, followed by 7-10 months of INH and RIF once a day (9 -12 months total)
d. Other (or cervical lymphadenopathy): same as for pulmonary TB
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