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Published on: September 5, 2017
How to manage children who have come into contact with patients affected by tuberculosis
Laura Lancella1, Andrea Lo Vecchio2, Elena Chiappini3
1Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy.
Insights
Childhood tuberculosis (TB) signifies recent infection in young children, indicating an undiagnosed source case. Guidelines help manage exposed children, assessing infection risk and treatment needs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Childhood tuberculosis (TB) in children under 5 years old is a sentinel event, signaling recent infection and an undiagnosed or untreated source case.
- TB transmission risk is influenced by bacillary load and exposure environment, especially during early life.
- Managing pediatric TB requires understanding transmission dynamics and risk factors for latent tuberculous infection (LTBI) and active disease.
Purpose of the Study:
- To provide recommendations from Italian scientific societies for managing children exposed to TB.
- To analyze risk factors for acquiring LTBI and developing TB in pediatric populations.
- To outline strategies for TB prevention, diagnosis, and treatment in young children.
Main Methods:
- Review of risk factors for TB acquisition and disease progression in children.
- Analysis of TB transmission specific to early childhood.
- Development of guidelines for managing exposed children, including index case identification and diagnostic testing.
- Recommendations for preventive chemoprophylaxis, LTBI management, and treatment protocols.
- Guidance on managing contact with multidrug-resistant or extensively drug-resistant TB cases.
- Inclusion of molecular typing for epidemic analysis.
Main Results:
- Identification of key risk factors for tuberculous infection and disease in pediatric age groups.
- Established protocols for evaluating children exposed to TB, considering age and immune status.
- Defined approaches for preventive chemoprophylaxis and treatment of LTBI.
- Specific management strategies for contacts of drug-resistant TB cases.
- Emphasis on the role of index case identification and molecular typing.
Conclusions:
- Childhood TB is a critical indicator of community transmission, necessitating prompt investigation.
- Comprehensive management strategies are crucial for children exposed to TB, adapting to individual risk factors and TB strain.
- These recommendations aim to improve the diagnosis, prevention, and treatment of TB in pediatric populations, particularly in the context of drug-resistant strains.
Abstract:
Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged < 5 years, and therefore is considered a sentinel event insofar as it highlights the presence of an undiagnosed or untreated source case. The risk of acquiring TB is directly proportional to the number of bacilli to which a subject is exposed and the environment in which the contact occurred. This document contains the recommendations of a group of Italian scientific societies for managing a child exposed to a case of TB based on an analysis of the risk factors for acquiring latent tuberculous infection (LTBI) and developing the disease, and the particular aspects TB transmission during the first years of life. The guidance includes a detailed description of the methods used to identify the index case, the tests that the exposed child should receive and the possibilities of preventive chemoprophylaxis depending on the patient's age and immune status, the chemotherapy and monitoring methods indicated in the case of LTBI, the management of a child who has come into contact with a case of multidrug-resistant or extensively drug-resistant TB, and the use of molecular typing in the analysis of epidemics. The group of experts identified risk factors for tuberculous infection and disease in pediatric age as well as gave recommendation on management of contacts of cases of TB according to their age, risk factors and exposure to multidrug-resistant or extensively drug-resistant TB.
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