Mumbai: Three children aged 12 to 16 died of disseminated tuberculosis (TB) at one of the major public hospitals in the city over the last month not due to lack of treatment but because private general practitioners failed to diagnose the disease early.Disseminated TB refers to the spread of the disease from the lungs to other organs. Sometimes, even chest physicians miss its signs in paediatric patients. For instance, a 15-year-old girl was sent to the hospital as a drug-resistant TB (DR-TB) patient without further evaluation. “All we were told was that she had a headache. As soon as she arrived, she collapsed and had to be put on a ventilator. She was severely neurologically impaired with meningitis,” said a doctor from the hospital’s paediatric department.The girl’s parents told the hospital that she had been vomiting for the past month: a classic telltale sign of disseminated TB. The hospital sees a few such cases every month. “Such patients visit general physicians first who fail to refer them to specialists till it is very late. That is what happened to the three who died,” the doctor said.The head of the hospital’s paediatric department said DR-TB remains a serious issue in children. “We are seeing every type of TB in children: abdominal, pulmonary, bone, brain, intestine, skin. Most of these patients rush in too late and in terrible distress, sometimes unconscious, with convulsions that cannot be controlled, and they all turn out to be TB patients.”Paediatric TB cases in Mumbai account for about 7-9% of all TB cases, according to data from BMC’s health department. The city reports around 60,000 TB cases annually. There is a considerable delay in seeking treatment for TB in the first place, and stigma as well as limited access play a role in this.Ganesh Acharya, a city-based TB-HIV activist, said, “A delay of two to three months in the treatment of children with TB is common. Families visit multiple general doctors who diagnose them with cough and cold, and in the end, it becomes a case of disseminated TB.”For children aged 12-16, delayed diagnosis is far more common as parents often stop consulting paediatricians and instead take them to general practitioners. A former paediatrician at Sion Hospital who routinely treated TB patients said, “There are complex reasons as to why general practitioners are unable to diagnose TB patients; one is that the manifestation of TB in children is very different than that in adults.“In children, it can show up as pleural effusion (fluid in chest) or severe bronchitis, said the doctor. “There’s a wide range of symptoms. That’s why general practitioners often don’t recognise it as TB.”Dr Tanu Singhal, paediatric consultant at Kokilaben Hospital, said, “TB is common even among well-off families. General practitioners may miss or sometimes misdiagnose it, but these families often go to specialists early themselves if the child doesn’t improve.”