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[Old and new aspects of childhood tuberculosis (author's transl)]
Insights
Early diagnosis of tuberculosis in children is crucial for preventing fatal outcomes and permanent disabilities. Improved awareness and adherence to tuberculosis testing protocols, including BCG vaccination follow-up, are essential.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Active tuberculosis cases in children treated over 8 years at the University of Innsbruck Pediatrics Department.
- None of the 50 children studied had received tuberculosis vaccination.
- A concerning trend of decreased awareness and knowledge regarding tuberculosis was observed.
Purpose:
- To highlight the critical importance of early diagnosis in pediatric tuberculosis.
- To emphasize the need for improved tuberculosis testing and interpretation.
- To advocate for enhanced vigilance and knowledge of tuberculosis in healthcare settings.
Summary:
- Three child deaths and permanent neurological damage in two others resulted from delayed tuberculosis diagnosis.
- Fatalities and severe sequelae, including miliary tuberculosis and tuberculous meningitis, were potentially avoidable with timely diagnosis.
- Suboptimal performance and interpretation of tuberculosis tests were noted, alongside a decline in clinical awareness.
Impact:
- Reinforces the necessity of prompt diagnosis to avert severe pediatric tuberculosis complications.
- Underscores the importance of standardized tuberculosis screening and follow-up protocols post-BCG vaccination.
- Calls for renewed focus on tuberculosis education and diagnostic proficiency among healthcare professionals to combat the disease effectively.
Abstract:
During the preceding 8 years 50 children were treated for active tuberculosis at the University of Innsbruck Department of Pediatrics. None of them were vaccinated against tuberculosis. Three children died; one of them from a fulminant miliary tuberculosis, two others from tuberculous meningitis; both of them were neurosurgically explored due to massive increase of intracranial pressure before a definite diagnosis was established. Two other patients, out of eleven with Tb-meningitis, are suffering permanent damages. Each one of the fatal cases and those with permanent sequelae could have been avoided by early diagnosis, which would have been possible in every case. It's our impression, that, with the decrease in the number of infected patients, there is also a decrease in the awareness and knowledge of this disease. We found the same to be true for the performance and interpretation of the Tb testing. Newborns immunized with BCG have to be tested for a positive tuberculine conversion to a dilution of Mantoux 1:100, preferably 3 months after the vaccination. Children with negative delayed sensitivity to tuberculin have to be reimmunized.