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Two sizes do not fit all: the terms infection and disease are inadequate for the description of children with tuberculosis
  1. James A Seddon
  1. Correspondence to Dr James A Seddon, Centre for International Child Health, Imperial College London, London, UK; james.seddon{at}

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The article by Loveday and colleagues published in this month’s edition of Archives of Disease in Childhood provides an opportunity to review some very old and some very new literature on paediatric tuberculosis (TB). The authors describe 43 children who had been referred from primary and secondary care, during 2010 and 2011, to a specialist childhood drug-resistant TB hospital in South Africa with cultures that were positive for drug-resistant Mycobacterium (M.) tuberculosis.1 The children were seen a median of 80 days after referral and a third of them had been given first-line TB treatment. The authors were unclear why these children had initially been investigated microbiologically for TB, but by the time they were seen in the specialist hospital, all had normal chest radiographs and had no symptoms or signs of TB. None had been given second-line TB treatment. Over the subsequent year or two, one child was started on treatment for drug-resistant TB disease, one children died and a few children were lost to follow-up. However, the majority remained well and free from TB disease.

So, what does this mean for us looking after children with TB and specifically drug-resistant TB? Traditionally, the term TB infection (or latent TB infection) suggests that a child is well, with no abnormal radiology, and that the child demonstrates immunological sensitisation to M. tuberculosis, as detectable through tuberculin skin testing or interferon-gamma release assay. For this to occur, organisms must …

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