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Modern approach to the diagnosis and treatment of tuberculosis in children
1Baylor College of Medicine, Houston, Texas.
Insights
Pediatric tuberculosis (TB) diagnosis and treatment in the US face challenges, with increasing extrapulmonary cases and drug resistance. Novel approaches are needed to improve care for children with this infectious disease.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Epidemiology
Background:
- Tuberculosis (TB) remains a significant infectious disease in the United States, with 1261 cases reported in 1985.
- Extrapulmonary TB manifestations are increasing in children.
- Advances in pediatric TB diagnosis and treatment lag behind adult care due to familiarity and study challenges.
Purpose of the Study:
- To highlight the challenges in diagnosing and treating tuberculosis in children.
- To discuss current diagnostic methods and emerging technologies.
- To emphasize the need for improved treatment strategies for pediatric TB.
Main Methods:
- Diagnosis relies on epidemiology, chest roentgenograms, skin tests, and contact tracing.
- Increasing drug-resistant TB necessitates obtaining cultures.
- Emerging diagnostic tools include DNA probes and serodiagnosis for improved accuracy, particularly in extrapulmonary TB.
Main Results:
- Pediatric TB predominantly occurs in high-risk populations: foreign-born, Hispanic, Black, Native American, and impoverished individuals.
- Drug-resistant TB rates are increasing, underscoring the importance of cultures.
- Noncompliance is a major challenge in pediatric TB treatment.
Conclusions:
- Improved diagnostic accuracy, especially for extrapulmonary TB, is needed.
- Novel treatment approaches, including supervised twice-weekly therapy and shorter, intensive durations, are crucial for pediatric TB management.
- Addressing noncompliance and developing tailored pediatric treatment strategies are essential.
Abstract:
Tuberculosis in children remains an important infectious disease in the United States, with 1261 cases reported in 1985. The percentage of extrapulmonary manifestations is increasing. Advances in the diagnosis and treatment of tuberculosis in children have lagged behind those in adults owing to diminished familiarity with the disease and difficulty in performing clinical studies in children. Tuberculosis in the United States now occurs mainly in clusters of high-risk people, such as the foreign born, Hispanics, blacks, Native Americans, and the impoverished. In general, the diagnosis of tuberculosis is epidemiologic, supported by the chest roentgenogram, skin test, and, most important, contact tracing. As the rate of drug-resistant tuberculosis increases, greater effort should be made to obtain cultures. New advances, such as DNA probes and serodiagnosis, may improve diagnostic accuracy, especially for extrapulmonary tuberculosis. Noncompliance is the major problem in treating tuberculosis, and greater effort should be directed toward novel treatment approaches in children, such as twice-weekly supervised therapy and shorter, more intense durations of therapy.