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Tuberculosis in children and its management
1Division of Pulmonary Medicine, University of Arkansas for Medical Sciences, Little Rock 72202-3591.
Insights
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.
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.
Abstract:
Children with tuberculosis (TB) in the United States are generally asymptomatic, 60% are under 5 years, 80% belong to racial/ethnic minorities or are foreign born, and most are diagnosed during the investigation of contacts of known cases of pulmonary TB. A presumptive diagnosis of primary TB is made on the basis of a positive tuberculin reaction and a characteristic chest roentgenogram, usually showing hilar adenopathy. Treatment may be with isoniazid (INH) and rifampin (RIF), largely twice weekly for 9 months, or INH, RIF, and pyrazinamide for 2 months followed for 4 months by INH and RIF. Four drugs are needed in cases of infection with drug-resistant organisms or in tuberculous meningitis. All therapy must be closely monitored for toxicity and compliance. In noncompliant families, all medication should be directly administered. This is now possible with short-course therapy, largely twice weekly. Preventive therapy for the tuberculin positive, but disease-free child, is provided more cost-efficiently with 6 months than with 12 months of treatment with INH; less than 6 months is not adequate. All tuberculin reactive children should receive INH for 6 months. More diligence in providing INH prophylaxis to adult reactors will decrease future infectious TB cases, and thus prevent transmission to other children.