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Tuberculosis in children--what has changed in last 20 years?
S K Kabra1, Rakesh Lodha, V Seth
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. skkabra@hotmail.com
Indian Journal of Pediatrics
|December 28, 2002
Summary
Childhood tuberculosis (TB) presents challenges due to HIV and drug resistance, increasing infection risk and mortality. Advances in diagnostics and treatment strategies like directly observed therapy offer improved outcomes for pediatric TB.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) epidemiology, clinical presentation, diagnostics, and treatment are evolving.
- The co-occurrence of the Human Immunodeficiency Virus (HIV) epidemic and drug-resistant TB strains presents significant global health challenges.
- Increasing adult TB cases and HIV spread are linked to rising childhood TB infection rates, particularly in developing nations.
Purpose of the Study:
- To review the changing landscape of childhood tuberculosis.
- To highlight challenges posed by HIV and drug resistance in pediatric TB.
- To discuss advancements in diagnostic and treatment modalities for childhood TB.
Main Methods:
- Literature review of epidemiological trends, clinical manifestations, and diagnostic advancements in childhood tuberculosis.
- Analysis of the impact of HIV and drug resistance on pediatric TB.
- Evaluation of current and emerging diagnostic techniques (e.g., nucleic acid amplification tests) and treatment strategies (e.g., short-course chemotherapy, directly observed treatment).
Main Results:
- Childhood TB accounts for an estimated 2.5% annual infection risk in developing countries, with 8-20% of TB deaths occurring in children.
- Lymph node TB and disseminated disease in HIV-infected children have increased.
- Drug-resistant TB rates vary widely (20-80%) geographically; nucleic acid amplification tests show promise but face limitations in pediatric application due to cost and expertise requirements.
Conclusions:
- Childhood tuberculosis remains a significant concern, exacerbated by HIV and drug resistance.
- While diagnostic tools are improving, challenges in sensitivity, specificity, and accessibility persist.
- Established treatments like short-course chemotherapy and directly observed treatment strategies demonstrate efficacy and are crucial for managing pediatric TB.