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Published on: September 5, 2017
Optimizing the management of children with latent tuberculosis infection
E Venturini1, C Tersigni1, E Chiappini1
1a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
Insights
Diagnosing latent tuberculosis infection (LTBI) in children is challenging due to imperfect tests. A three-month treatment of isoniazid and rifampicin is recommended for safety and efficacy.
Area of Science:
- Pediatric infectious diseases
- Tuberculosis research
- Public health
Background:
- Latent tuberculosis infection (LTBI) management in children is critical due to disease burden and progression risk.
- Accurate diagnosis of LTBI in pediatric populations remains a significant challenge.
- Current diagnostic methods lack a gold standard for differentiating infection from active disease.
Purpose of the Study:
- To provide an updated overview of LTBI diagnosis, management, and treatment in children.
- To review current literature on LTBI in pediatric populations.
- To inform clinical practice and future research directions.
Main Methods:
- Systematic review of English language articles on pediatric LTBI.
- Literature search conducted on PubMed using specific keywords and standardized terminology.
- Inclusion criteria: articles published between January 1, 2010, and July 1, 2016.
Main Results:
- Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are available but have suboptimal specificity and sensitivity.
- Neither TST nor IGRA can reliably distinguish between LTBI and active tuberculosis disease.
- A three-month regimen of isoniazid and rifampicin is recommended for its safety and efficacy profile.
Conclusions:
- Improved diagnostic tools for pediatric LTBI are needed.
- The recommended treatment regimen enhances patient adherence and treatment completion rates.
- Development of new tuberculosis vaccines is crucial given the ongoing spread of the disease.
Introduction:
The management of latent tuberculosis (LTBI) in children represents an important issue for paediatricians because of the disease burden, the lack of a gold standard for the diagnosis and the high annual risk of progression to active disease. Areas covered: A review of English language articles on LTBI in children, published between the 1st of January 2010 and the 1st of July 2016, was conducted using multiple keywords and standardized terminology in PubMed database. This review provides an updated overview of the available tests for LTBI diagnosis in children, management strategies and treatment options. Expert commentary: Two tests are available for LTBI diagnosis: tuberculin skin test and interferon-gamma release assays, both with a suboptimal specificity and sensitivity, and both with the lack of capability in distinguishing between infection and disease. Several new markers have been identified but further studies are needed. Among all treatment regimes, because of the high safety and efficacy profile showed and to avoid the poor completion rate, the treatment with a three-month course of isoniazid and rifampicin is currently recommended. New vaccines are needed because of the spread of the disease despite BCG vaccination in high risk countries. Currently, 15 new vaccines are in the pipeline.
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