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[Infants and children who developed tuberculosis following contacts investigation]
1Division of Respiratory Disease, Tokyo Metropolitan Children's Hospital, 1-3-1, Umezono, Kiyose-shi, Tokyo 204-0024, Japan. shykondo@chp-kiyose-tokyo.jp
Object:
Reevaluating the important points in tuberculosis contacts investigation.
Subject And Methods:
We retrospectively examined the medical charts of 25 infants and children who developed tuberculosis following contacts investigation.
Results:
In thirteen patients, diagnosis of infection was missed, and three of five infants less than one year old suffered from meningitis or military tuberculosis while they were waiting the next examination. Three patients were not indicated preventive treatment despite of induration of 5 mm or more in tuberculin skin test. Other twelve patients including five infants less than one year old were diagnosed to have tuberculosis infection and started preventive therapy, however, tuberculosis developed in 10 patients while taking the medicine, and in two patients probably because of defaulting from taking the medicine.
Conclusion:
These results suggest that the contacts investigation have to be done promptly and be flexible based on age of contacts, evaluation of tuberculin skin test results and radiographic findings in order to reduce the disease further.
Insights
Prompt tuberculosis contact investigations are crucial, especially for infants. Timely and flexible evaluations, considering age and test results, can help prevent disease progression in pediatric tuberculosis cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Tuberculosis (TB) contact investigations are vital for early detection and prevention of disease spread.
- Infants and children are particularly vulnerable to severe TB complications.
- Current contact investigation protocols may have limitations in identifying and managing at-risk pediatric populations.
Purpose:
- To reevaluate key aspects of tuberculosis contact investigations.
- To identify missed diagnoses and treatment delays in pediatric TB contacts.
- To assess the effectiveness of current diagnostic and preventive strategies in children.
Summary:
- A retrospective study of 25 infants and children who developed TB post-contact investigation revealed significant diagnostic delays.
- Thirteen patients had their infections missed; three infants under one year old developed severe TB (meningitis or miliary TB).
- Preventive treatment was delayed or missed in some cases despite positive tuberculin skin tests (TST).
- Even with treatment, 10 of 12 patients developed TB, possibly due to medication adherence issues.
Impact:
- Highlights the need for prompt and flexible tuberculosis contact investigations tailored to pediatric age groups.
- Emphasizes the importance of accurate interpretation of TST results and radiographic findings in children.
- Suggests improved strategies are necessary to reduce the burden of tuberculosis in young contacts.
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