Fate of Children Infected With Tuberculosis During the First Five Years of Life

Abstract

There is increasingly less pessimism concerning the fate of children infected with tuberculosis during infancy. The reason for this change lies partly in the progressively improving ability of the medical profession to diagnose mild and subclinical tuberculosis in infants and young children. Before the discovery of the tuberculin test and the roentgen rays, only those infants who presented clinical signs were regarded as tuberculous. The prognosis of such infants was and still is grave. However, apparently well children whose only sign of tuberculous infection is a positive reaction to the tuberculin test or an abnormal appearance of the lungs in a roentgenogram of the chest are now known. They really belong in a different category than do the clinically ill children and have a much better prognosis. Since the term tuberculous infants is used for both types of patients and since the recent literature more frequently deals with the subclinical type, the impression of an improving prognosis for tuberculosis in infants is created.However, even if one allows for the difference in the type of the tuberculous patients with which the recent literature deals, the course of tuberculous infection in children at present appears to be mild more frequently than in the past. It is probable that because of improved technic in diagnosis more persons who are sources of infection are recognized early now than in former years. Early diagnosis involves early precautions and measures for the prevention of the spread of the disease. It is reasonable to assume that fewer infants than for¬ merly are now exposed to massive doses of tubercle bacilli.It may be inferred, therefore, that the milder tuberculous infections and the greater number of early and subclinical diagnoses among infants are responsible for the apparently lower rate of deaths from tubercu¬ losis among infants and children reported in the recent medical litera¬ ture. If one could compare strictly analogous types of tuberculous infants of half a century ago and of the present, the difference in Downloaded From: http://archpedi.jamanetwork.com/ by a University of Michigan User on 06/21/2015