Clinical scenario: persistent fever | cough | poor weight gain
A 3-year-old child presents with persistent fever, cough, and poor weight gain for 6 weeks. His parents report reduced appetite and lethargy. There is a history of close contact with his uncle, who was treated for smear-positive pulmonary tuberculosis 3 months ago. Examination reveals weight below the 5th centile and palpable cervical lymph nodes. Chest X-ray shows right hilar lymphadenopathy with a focal opacity in the right middle lobe.
What is the most likely diagnosis?
A. Primary pulmonary tuberculosis
B. Bacterial pneumonia
C. Bronchiectasis
D. Foreign body aspiration
E. Viral bronchiolitis
Correct answer & Explanation:
Correct answer: A. Primary pulmonary tuberculosis
Explanation:
In young children, primary pulmonary TB commonly presents with:
- Prolonged cough and fever
- Poor weight gain/failure to thrive
- TB contact history
- Hilar or mediastinal lymphadenopathy on chest X-ray
- Parenchymal lesion (primary complex)
Children usually develop primary disease rather than adult-type cavitary disease because their immune response is immature.
Why other options are incorrect:
- B. Bacterial pneumonia: Usually has acute onset with higher fever and responds to antibiotics.
- C. Bronchiectasis: Causes chronic productive cough and recurrent infections but not typical hilar lymphadenopathy.
- D. Foreign body aspiration: Usually sudden onset with localized wheeze or collapse.
- E. Viral bronchiolitis: Occurs mainly in infants and is an acute illness.
