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[Tuberculosis in children]
1Service de Pneumologie Pédiatrique, Hôpital d'Enfants Armand-Trousseau, Paris.
Insights
Tuberculosis remains a concern in the Paris area, particularly affecting children under five. Early detection via tuberculin testing and prolonged combined chemotherapy are key to managing pediatric tuberculosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Context:
- Tuberculosis incidence is low in developed countries, yet persists in specific areas like Paris.
- Pediatric tuberculosis (TB) disproportionately affects children under five years old.
- TB eradication has been achieved in several French regions, highlighting regional disparities.
Purpose:
- To describe the epidemiological and clinical characteristics of tuberculosis in children in the Paris area.
- To outline diagnostic challenges and common complications of pediatric TB.
- To discuss current treatment strategies for childhood tuberculosis.
Summary:
- Pediatric tuberculosis in Paris shows a high incidence in children under five, with lung and lymph node involvement being most common.
- Typical complications include endobronchial fistulization and atelectasis; direct examination often fails to detect Mycobacterium tuberculosis.
- Latent primary infection, diagnosed by the tuberculin test, is frequent. Treatment involves 2-3 years of combined bacteriocidal antibiotic chemotherapy.
Impact:
- Highlights the ongoing risk of pediatric tuberculosis in urban settings within developed nations.
- Emphasizes the importance of early diagnosis and appropriate treatment for better outcomes in children.
- Informs public health strategies for tuberculosis control in high-risk populations and regions.
Abstract:
In developed countries like France, the incidence of tuberculosis is low, 5 to 6% in patients under 15 years of age. At the present time, tuberculosis has been irradicated in 11 French regions. Inversely, tuberculosis is still found in the Paris area. Half of the children with tuberculosis are under 5 years of age, underscoring the high risk at this age. Lung and lymph node infection is most often encountered in children with typical complications of endobronchial fistulization and segmentary or lobular atelectasy. Direct examination does not reveal germs in more than 80% of the cases. Other forms are more rarely found in children although congenital, meningeal, serofibrinous pleural, and cervical lymph node tuberculosis are sometimes observed. Latent primary infection, by far the most frequent, can only be recognized by the intradferal tuberculin test. Systematic treatment modalities would now center on the use of combined chemotherapy using two bacteriocidal antibiotics for 2 or 3 years.