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Tuberculosis in children and its management.

R S Abernathy1

  • 1Division of Pulmonary Medicine, University of Arkansas for Medical Sciences, Little Rock 72202-3591.

Seminars in Respiratory Infections
|September 1, 1989
PubMed
Summary

Pediatric tuberculosis (TB) in the US often affects young children from minority backgrounds and is diagnosed via contact tracing. Six months of isoniazid preventive therapy is recommended for tuberculin-reactive children to prevent disease transmission.

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Pediatric tuberculosis (TB) in the US is frequently asymptomatic, disproportionately affecting children under five and those from minority or foreign-born populations.
  • Diagnosis typically occurs through contact investigations of known pulmonary TB cases.
  • Presumptive diagnosis relies on a positive tuberculin reaction and characteristic chest X-ray findings, often showing hilar adenopathy.

Purpose of the Study:

  • To outline the diagnostic and treatment strategies for pediatric tuberculosis in the United States.
  • To emphasize the importance of preventive therapy for children and adults to reduce TB transmission.
  • To highlight the efficacy and cost-effectiveness of short-course preventive therapy.

Main Methods:

  • Review of diagnostic criteria for primary TB in children, including tuberculin skin testing and chest radiography.
  • Description of current treatment regimens, including standard short-course therapies with isoniazid (INH) and rifampin (RIF), and multi-drug options for resistant cases or meningitis.
  • Discussion of preventive therapy strategies, comparing 6-month versus 12-month isoniazid (INH) courses.

Main Results:

  • Pediatric TB cases are often diagnosed in young children (<5 years) from minority or foreign-born backgrounds.
  • Standard treatment involves 6-9 months of combined isoniazid (INH) and rifampin (RIF), with adjustments for drug resistance or meningitis.
  • Six months of INH preventive therapy is adequate and cost-effective for tuberculin-reactive children, reducing future TB cases.

Conclusions:

  • Early diagnosis and adherence to closely monitored treatment regimens are crucial for managing pediatric TB.
  • Six months of isoniazid (INH) preventive therapy is recommended for all tuberculin-reactive children.
  • Increased INH prophylaxis in adult reactors is essential to decrease infectious TB cases and prevent pediatric transmission.

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