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Published on: September 5, 2017
Tuberculosis in children from diagnosis to decision to treat
S Ramos1, R Gaio2, F Ferreira3
1Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Insights
Diagnosing childhood tuberculosis (TB) is challenging. Clinician experience and setting influence treatment decisions, highlighting the need for standardized guidelines for pediatric TB management.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Confirmation of tuberculosis (TB) in children presents diagnostic challenges.
- Clinicians often rely on varied procedures when deciding on treatment initiation for pediatric TB.
- Lack of definitive diagnostic confirmation complicates management of TB in young children.
Purpose of the Study:
- To identify criteria used by clinicians for initiating and maintaining anti-TB treatment in children under five years old.
- To explore factors influencing treatment decisions in pediatric TB cases lacking microbiological confirmation.
Main Methods:
- A web-based survey was emailed to authors of childhood TB journal articles.
- Data from 64 respondents (24.6% response rate) were analyzed.
- Observations were clustered and analyzed using Ward's method to identify patterns in clinical decision-making.
Main Results:
- 71.9% of respondents deemed microbiological confirmation unimportant for initiating TB treatment, prioritizing epidemiological context and symptoms.
- 95.3% based treatment continuation primarily on clinical improvement.
- Clinician experience, age, and work setting influenced diagnostic tool preferences (e.g., IGRA, CT scans, chest X-rays) and interpretation of radiological findings.
Conclusions:
- Pediatric TB management strategies vary significantly based on clinician demographics and practice environment.
- There is a critical need for standardized diagnostic and treatment guidelines for childhood TB.
- Standardized guidelines would improve consistency and potentially outcomes in managing TB in children.
Setting:
Confirmation of tuberculosis (TB) in children is difficult, so clinicians use different procedures when deciding to treat.
Objective:
Identify criteria to initiate and maintain TB treatment in children younger than 5 years-old, without diagnosis confirmation.
Design:
A web-based survey was distributed by email to the corresponding authors of journal articles on childhood TB. The observations were clustered into disjoint groups, and analyzed by Ward's method.
Results:
We sent out 260 questionnaires and received 64 (24.6%) responses. Forty-six respondents (71.9%) said that microbiological confirmation was not important for initiation of anti-TB treatment, and that the epidemiological context and signs/symptoms suggestive of disease were most important. Sixty-one respondents (95.3%) said that the decision to continue therapy was mainly dependent on clinical improvement. A cluster of older respondents (median age: 52 years-old) who were active at a hospital or primary health care centre placed the most value on immunological test results and chest X-rays. A cluster of younger respondents (median age: 38 years-old) who were less experienced in management of TB placed more value on Interferon Gamma Release Assay (IGRA) results and chest computed tomography (CT) scans. A cluster of respondents with more experience in treating TB and working at specialized TB centres placed greater value on the clinical results and specific radiological alterations ("tree-in-bud" pattern and pleural effusion).
Conclusion:
TB management varied according to the age, work location and experience of the clinicians. It is necessary to establish standardized guidelines used for the diagnosis and decision to treat TB in children.
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