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Care priority and warning signs
Care priority
Refer for Assessment
Red flags
- Any danger sign (PSBI/VSD signs).
- Signs of meningitis.
- Respiratory distress.
- Failure to thrive.
Assessment
- Ask: History of contact with a person with PTB or chronic cough?
- Ask: Persistent fever (>14 days)?
- Ask: Persistent cough (>14 days)?
- Check: Does infant have pneumonia not responding to standard therapy?
- Check: Weight for age. Is it <1.5kg? Is WFA Z-score < -3?
- Check: Presence of ANY danger sign (implies severe illness, increasing TB suspicion if other symptoms present).
Classification
- Presence of ANY of the symptoms and signs suggestive of TB (contact Hx, cough>14d, fever>14d, non-responsive pneumonia) OR Weight less than 1.5kg OR WFA < -3 Z score -> PRESUMPTIVE TB
Key features
- Presence of ANY symptom suggestive of TB (persistent cough/fever, non-responsive pneumonia, contact history) OR Very low weight (<1.5kg or WFA<-3Z) triggers suspicion.
- Diagnosis is challenging in this age group; high index of suspicion needed.
- Requires referral for specialized investigation (e.g., gastric aspirates, X-ray, GeneXpert) and management.
- Young infants with danger signs also warrant TB consideration and referral.
Management
Non-pharmacological management
- Keep infant warm.
- Support feeding.
- Refer to hospital for further assessment and management.
Pharmacological treatment
- If danger signs also present, provide pre-referral treatment for PSBI/VSD (Antibiotics, prevent hypoglycemia - Page 40) before referral.
- TB treatment is typically initiated at referral center after investigation.
Pre-referral treatment
- Manage any danger signs (PSBI/VSD treatment - Page 40).
- Keep warm.
- Support feeding.
Follow-up
- To be managed at referral hospital / TB clinic.
Counselling points
- Explain that the baby has signs that might indicate TB and needs further tests at the hospital.
- Explain any pre-referral treatments given.
- Advise on keeping infant warm and continuing feeding during transport.
- Ask about caregiver's health (possible TB source) and advise testing if needed.
- Write a detailed referral note listing signs, symptoms, weight, and reason for TB suspicion.
Differential diagnosis
- PSBI / Sepsis
- Severe Pneumonia (bacterial/viral)
- Congenital infection
- Malnutrition / Failure to thrive (non-TB causes)
- Congenital lung/airway anomalies
Complications
- Disseminated TB (miliary, meningitis)
- Severe pneumonia
- Death
Prevention
- BCG vaccination at birth.
- Early identification and treatment of infectious TB cases in household.
- IPT for eligible exposed infants (though usually started >2 months).
References
IMCI Chart Booklet - Page 37