1. Tuberculosis (T.B.)
The child may present with fever, cough, weight loss, decreased appetite and a general feeling of ill being, listlessness and apathy. The most important fact to determine is whether the child had a close contact with an adult T.B. patient, as it is an infectious disease that spreads through airborne bacteria. T.B. usually does not spread from a child to another child, as the child does not release many T.B. bacteria in the air due to lack of a forceful cough and absence of a cavity in the lungs (which adults have).
The adult, with coughing releases T.B. bacteria in the air, which the child inhales, thus infecting him. Don’t feel embarrassed in telling the doctor that there is an auult in the family suffering from T.B., because this helps the doctor in arriving at a diagnosis. Since the diagnosis of T.B. often is based on exposure to a positive contact, the reluctance of the parents to come out with the truth leads to a delay in the diagnosis of the disease, to the detriment of the child.
T.B. is a disease that is completely treatable, provided the patient takes the medicines regularly and also completes the whole course, which nowadays is usually of 6 months. A not so uncommon scenario is the patient stopping the medicines after 1 or 2 months when he/ she feels all right, a nightmare for the doctors because this may lead to drug resistance for T.B. and then becomes very difficult to cure.
I have seen T.B. being over-diagnosed frequently, particularly in children, when any child having a chronic cough or recurrent respiratory infections is “empirically” put on T.B. treatment. If the child becomes well after 1-2 weeks of treatment, the parents and the treating doctor think that the child had T.B. and thus has responded to the drugs against T.B.
But it is quite possible that the child had some other disease (e.g. a prolonged viral illness or a respiratory allergy or pertussis, described below), which by now has completed its disease cycle and thus would have got cured of its own accord without any medications! This is what I mean by over diagnosis and the parents should be wary and aware of this pitfall. So if the parents have doubts in their minds regarding the diagnosis, don’t hesitate to seek a second opinion preferably of a specialist in the field.
A new blood test called as ELISA test for T.B. has nowadays become very popular and even educated parents ask the doctor for it, as if it is the definitive diagnostic test that will once and forever decide whether the child is having T.B. or not. In fact the test is of dubious value and cannot prove that a person is having active T.B. So going for this expensive test is burning a hole in your pockets. The same information can be obtained by a relatively simpler and non-expensive skin test called “Mantoux test.”
2. Polio
The Polio virus is excreted in the stools of an infected patient from where it can infect others via the oral route. A dreaded disease of childhood, contracted usually due to the negligence of the parents in not getting their child properly immunised, it may cause paralysis of one or more extremities which may be devastating as the child may be left with permanent disability. Unfortunately once a child gets Polio there is no cure. So the only hope lies in prevention through vaccination.
Polio is now on the agenda of the WHO (World Health Organisation) to be eradicated from the world (like smallpox was eradicated) through a program called “Pulse Polio Program.” In this program, every child below the age of 5 years is immunised simultaneously every year by 2 doses given at 1 month interval. Parents should give their child these Polio drops, even if they have received Polio drops from their child specialist 1 day back. More than necessary doses of Polio do not do any harm to the child.
3. Diphtheria
The typical presentation is that of a whitish-grey membrane in the throat, which may cause coughing, sore throat and fever plus a swelling of the neck due to enlarged lymph nodes (often called “bull neck”). If the membrane progresses to involve the voice box (larynx), it may lead to breathing difficulty in the child often with a noisy and laboured breathing. In some cases it may even be fatal. The toxin of diphtheria can lead to many complications like heart failure and paralysis of the muscles by damaging their nerve supply. Though a cure is available in the form of anti-toxin and antibiotics, considering its serious nature, one must go for prevention by DTP vaccine than cure.
4. Pertussis
It is a bacterium which clogs the lungs with mucus. This leads to a severe and prolonged cough. Also called whooping cough or a 99-day cough because of its prolonged nature, it is characterised by severe spasmodic coughing, lasting for weeks. The child goes on coughing many times during a single breath and at the end takes a deep breath to fill his lungs again with air. This deep breath sometimes produces a crowing sound called as whoop. Sometimes the child may gag and vomit at the end of one of these long spells of coughing.
An airborne disease, it is contracted by close contact with a person suffering from pertussis, who while coughing releases the pertussis bacteria in the air. The cough is very distressing and can be initiated by even a mild stimulus like feeding or a sudden noise. Though the drug, erythromycin, is prescribed for it and it does kill the bacteria and limits further spread of the disease, it is not of much help for the coughing episodes, which becomes less severe in intensity with time only.