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Published on: September 5, 2017
Update on trends in childhood tuberculosis
Samantha Fry1, Shaun Barnabas2, Mark F Cotton2
1Department of Paediatrics and Child Health, Tygerberg Hospital.
Insights
Recent advances in pediatric tuberculosis (TB) diagnosis and treatment offer improved case identification and child-friendly therapies. Ongoing research focuses on novel drugs for drug-resistant TB in children, aiming to combat this global health challenge.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) presents significant morbidity and mortality in children, with diagnosis and treatment posing challenges.
- Recent research and clinical trials are increasing focus on pediatric TB, improving management and identification.
- Global initiatives aim to end the TB epidemic by 2030-2035, necessitating advancements in child-specific strategies.
Purpose of the Study:
- To review recent advancements in the diagnosis and treatment of pediatric tuberculosis (TB).
- To highlight improvements in case identification and management of both drug-susceptible and drug-resistant TB in children.
- To discuss emerging therapeutic strategies and diagnostic tools for childhood TB.
Main Methods:
- Review of recent scientific literature and clinical trial data on pediatric TB.
- Analysis of diagnostic methods, including immunological assays and molecular diagnostics like Xpert MTB/RIF.
- Evaluation of current and emerging treatment regimens for drug-susceptible and drug-resistant TB in children.
Main Results:
- Novel diagnostic approaches, such as M. tuberculosis-specific CD4/CD8 cell stimulation and improved sampling methods, enhance case identification.
- Xpert MTB/RIF offers improved detection of M. tuberculosis in clinical samples.
- Paediatric-friendly dispersible fixed-drug combinations are available for drug-susceptible TB, improving adherence.
- Research into newer, effective drugs for drug-resistant TB in children is ongoing.
Conclusions:
- Significant progress has been made in pediatric TB diagnosis and treatment, with more child-friendly options emerging.
- Continued research and implementation of effective national TB programs are crucial, especially in high-burden settings.
- Addressing drug-resistant TB in children requires further investigation and adaptation of adult treatment protocols.
Purpose Of Review:
Although tuberculosis (TB) causes much morbidity and mortality in children, diagnosis and treatment remain challenging. Recently, children have gained increasing attention in research and clinical trials driving improved contact management, case identification and treatment of both drug-susceptible and drug-resistant TB. This review highlights some recent advances.
Recent Findings:
The tuberculin skin test is the most widely used test to distinguish Mycobacterium tuberculosis (M. tuberculosis) infection from active TB, however, using M. tuberculosis-specific, antigenic stimulation of CD4 and CD8 cells appear more effective. The use of Xpert MTB/RIF to identify M. tuberculosis in clinical samples, together with novel sampling methods have in part, overcome the difficulty of sampling and increased case identification capacity. Advances in treating both drug-susceptible and drug-resistant childhood TB show promise in being more paediatric friendly and improving adherence. Dosing strategies for drug-sensitive TB have improved with dispersible fixed drug combinations now available. In the treatment and prevention of drug-resistant TB, however, research involving the use of newer and more effective drugs currently recommended for adults, are still ongoing in children.
Summary:
The World Health Organization aims to end the TB epidemic by 2035 whereas the United Nations' Sustainable Developmental Goals sets this ambitious target for 2030. Therefore, adequate funding and implementing effective national TB programs must be prioritized, particularly in high-burden, low-income settings.
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