Related Experiment Videos
[The current situation and treatment of childhood tuberculosis]
1Department of Pediatrics, Osaka Prefectural Habikino Hospital, Japan.
Insights
Tuberculosis (TB) remains a concern in Japan, particularly in children under five. Early detection of adult TB patients, contact tracing, BCG vaccination, and protection against multidrug-resistant TB are crucial for childhood TB elimination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Tuberculosis (TB) poses a significant public health challenge, especially in pediatric populations.
- A retrospective analysis was conducted on 394 pediatric TB cases treated between 1976 and 1997 in Japan.
- Diagnosis relied on contact history, tuberculin skin tests, bacteriology, and radiographic findings.
Purpose:
- To analyze the epidemiological characteristics and treatment outcomes of childhood tuberculosis in Japan.
- To highlight the persistent threat of TB meningitis (TBM) and multidrug-resistant TB (MDR TB) in children.
- To identify key strategies for the control and elimination of childhood TB.
Summary:
- The study reviewed 394 pediatric TB cases, with 54% under five years old. Primary pulmonary TB was most common (200 cases), followed by post-primary pulmonary TB (97 cases).
- Tuberculosis meningitis (TBM) affected 28 children, with a concerning mortality rate and severe neurological sequelae in survivors, particularly in the 1990s.
- BCG vaccination rates were low, especially in children under five (13.6%), and 26 TBM cases had no prior BCG vaccination.
Impact:
- The findings underscore the need for improved TB control measures in Japan, including enhanced BCG vaccination strategies and early detection of infectious adult cases.
- Recommendations include prompt contact tracing, chemoprophylaxis, and protection against MDR TB to prevent severe outcomes and eliminate childhood TB.
- Effective treatment regimens for TBM (12 months) and pulmonary TB (6 months) are essential for successful patient recovery and disease control.
Abstract:
We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. The diagnosis criteria for establishing TB were history of direct contact with TB patients, tuberculin skin test reactivity, positive bacteriology and radiographic findings compatible with TB. There were 192 males and 202 females (age range 1 month to 18 years of age, mean 6.3 years of age). Fifty-four percent of the cases were under 5 years of age. Primary pulmonary TB was presented in 200, post primary pulmonary TB in 97, pleural effusion in 53, endbronchial TB in 4, TB meningitis (TBM) in 28, miliary TB in 28 and other extra-pulmonary TB in 31. A history of contact with the patients was obtained in 72.8% of cases. Two hundred and thirty (58.4%) had received BCG, 134 (34%) no BCG, 30 (7.6%) were unclear. Especially, under 5 years of age, only 29 (13.6%) had received BCG. TBM is not disappeared in Japan and there were 28 cases with TBM. Fifteen patients out of them recovered completely, 8 patients recovered with severe neurological sequelae which included mental retardation, motor weakness, seizures and hydrocephalus and 5 patients died. Twenty-six had no BCG. Particularly in 1990s, we had experienced 4 dead TBM cases, 1 multi-drug resistant (MDR) TBM case and 1 TBM case due to nosocomial infection. Children with TBM should received 12-month regimen using initial daily treatment with isoniazid, rifampin, pyrazinamide, and streptmycin, followed by isoniazid and rifampin administered daily. Pulmonary TB in children is successfully treated with 6-month standard chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR TB are most important in Japan.