Indications for Treatment of Tuberculosis

in Children*
EDITH XI. LINCOLN, hl.D., New Iyork, New }‘or/r

l.‘rom tbe Depurtment of Pediatrics, New Ehrk University. measles and given gamma globulin if exposed.
College of Medicine, and tbe Cbest Clinic of tbe Children’s Diet should be IiberaI in caIories and in foods
Medical Service, Bellevue Hospital, New Iyork, N. E’.
high in protein and fat, and supplementary
VERY form of tuberculosis may be seen in vitamins shouId be given.
E chiIdren. However, the great majority of The degree and duration of conservative
clinica pictures are manifestations of primary treatment wiI1 vary with the extent of tubercu-
or first infection puImonary tuberculosis and Ious disease but, in generaI, activity is in-
are due to IocaI progression of the disease at the creased gradually after six months have passed
porta of entry or to compIications due to and most restrictions are lifted after a ,vear
metastasis through the Iymphohematogenous since most observers agree that more than
route. Chronic pulmonary tuberculosis, often 90 per cent of serious complications occur
called reinfection tuberculosis, occurs much within the first year after the diagnosis of
more rareIy in the child than in the adult. primary tuberculosis.
lloreover, the cIinica1 course and the treatment
SELECTION OF CASES FOR SPECIFIC THERAP
of chronic puImonary tubercuIosis is essentialI>
the same at a11 ages. Therefore, this presenta- The selection of patients who need specific
tion wiI1 be Iimited to a discussion of the indica- antimicrobial therapy in addition to conserva-
tions for treatment of primary tuberculosis and tive treatment is based IargeIy on the estimated
of the many complications lvhich constitute its prognosis of each individual patient. It is ob-
clinica picture.’ viousIy mandatory to treat patients with forms
of tuberculosis who had a high death rate prior
GENERAL MANAGEMENT OF THE to the use of specific therapy. Meningitis and
TUBERCULOUS CHILD miliary tuberculosis, which were practically
Every child with active primary tuberculosis, IOO per cent fatal before chemotherapy, must
regardless of the presence or absence of symp- of course be treated. In addition there are two
toms, is entitIed to exceIIent genera1 care and other main causes of death in tuberculous
supervision. A chiId with uncompIicated pri- children for which treatment is essential: (I)
mary tubercuIosis need not be treated in a locally progressive primary pulmonary tuber-
hospita1 or sanatorium unIess his home is inade- culosis with cavitation and bronchogenic
quate for his care or the source case remains in spread, and (2) various forms of hematogenous
the home. Limitation of activity is desirable tuberculosis more protracted than miIiary in
during the early months of the disease even if which multipIe foci of tubercuIosis are pro-
the chiId is afebriIe. The chiId need not be kept duced by blood stream invasion.2 Such forms
in bed nor indoors, but pIay must be supervised of tubercuIosis must be treated as a lifesaving
and toys selected to minimize excitement and measure. In untreated meningitis the average
overactivity. Children of school age who are duration from first symptom to death was
past the acute stage of the disease may attend only nineteen and a haIf days. Therefore, once
school if afebriIe and provided physical activi- the diagnosis of meningitis is established it is
ties can be restricted. Excessive exposure to important to give the most efficient anti-
sunIight shouId be avoided, and the chiId with microbia1 agents, streptomycin and isoniazid
active tubercuIosis shouId be shieIded from together and in maximum dosage, changing
* This study was aided by grants from the committee on Medical Research of the American Trudeau Society,
medica section of the NationaI TubercuIosis Association; from the Division of Research Grants and Fellowships of
the NationaI Institutes of Health, PubIic Health Service; from Parke, Davis and Company.

645