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[Active tuberculosis in children who received INH chemoprophylaxis]
K Ikeda1, M Sugimori, K Kawasaki
1Department of Pediatrics, School of Medicine, Keio University, Tokyo, Japan.
Insights
Active tuberculosis can still develop in children despite isoniazid (INH) chemoprophylaxis. Factors like young age, high M. tuberculosis exposure, and delayed INH initiation increase risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Isoniazid (INH) chemoprophylaxis is a standard preventive measure for tuberculosis (TB).
- Breakthrough TB cases after INH prophylaxis highlight potential gaps in treatment efficacy or patient management.
- Understanding risk factors is crucial for optimizing TB prevention strategies in children.
Purpose:
- To analyze cases of active tuberculosis in children who received isoniazid chemoprophylaxis.
- To identify factors associated with treatment failure or delayed diagnosis of TB post-prophylaxis.
Summary:
- Twelve children developed active TB despite receiving adequate INH doses.
- No isoniazid-resistant Mycobacterium tuberculosis strains were identified.
- Key risk factors included young age (<2 years), high bacillary load from infectious sources, and delayed INH initiation.
Impact:
- Findings underscore the need for careful consideration of patient age, exposure risk, and timely INH administration.
- Highlights the importance of vigilant follow-up for children undergoing TB chemoprophylaxis.
- Informs clinical practice and public health strategies for TB prevention in pediatric populations.
Abstract:
Twelve children who developed active tuberculosis even after receiving isoniazid (INH) chemoprophylaxis were seen at Tokyo Metropolitan Children's Hospital from 1982 through 1991. All cases received INH more than 9 mg/kg/day, except for one case in which the amount of INH administered at the referring hospital was unknown and Streptomycin was administered together with INH. The age of starting INH prophylaxis ranged from 2 months to 13 years, and the age at which clinical symptoms and/or laboratory evidences of active tuberculosis were first manifested ranged from 4 months to 18 years. Five patients developed active tuberculosis after the completion of chemoprophylaxis and patients during chemoprophylaxis, with the first presentation ranging from primary complex (seven), chronic pulmonary tuberculosis (two), tuberculous meningitis (two), and tuberculous pleuritis (one). None of the Mycobacterium tuberculosis resistant to INH was isolated. Reviewing these patients, eleven cases had at least one of the following factors: (1) age less than two years old (2) infectious sources expectorated more Mycobacterium tuberculosis (3) delay in starting INH. Above factors should be considered in initiating INH chemoprophylaxis and subsequent follow-up of the patients.