Tuberculosis in Children

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Epidemiology of childhood tuberculosis

The knowledge of the global epidemiology of TB in children is somewhat limited. In 1990, approximately 7,500,000 TB cases occurred worldwide, of which 650,000 occurred in children [1]. In 2002, the WHO estimated that 8,800,000 TB cases occurred worldwide, based on data from 209 countries with an estimated mean case rate of 145 per 100,000 population (range, 2–1067 cases) [2]. Although estimates, these numbers can be particularly useful when assessing the effectiveness of TB control programs.

Risk factors for latent tuberculosis infection and progression to tuberculosis disease

Several recent studies have assessed the risk factors for LTBI among children in the United States. Risk factors varied somewhat from study to study but generally included close contact with a TB case, birth in a country with high prevalence of TB, travel to or a household visitor from a high-prevalence country, a family member with LTBI, contact with a high-risk adult (eg, an adult who is infected with HIV/AIDS, homeless, incarcerated, or a user of illicit drug) and age greater than 11 years

Pathogenesis

The pathogenesis of pediatric TB is largely similar to that described for adults and older adolescents, but subtle differences in pathogenesis can lead to differences in clinical presentations. As in adults, more than 98% of infections in children occur when M. tuberculosis bacilli enter the lungs through aerosolized droplets expelled when an infectious adult coughs, sneezes, or sings [6]. Other less common portals of entry include the gastrointestinal tract, the skin, mucous membranes, and

Latent tuberculosis infection

In both adults and children, LTBI is defined as infection with M. tuberculosis as evidenced by a positive TST and lack of clinical or radiographic signs or symptoms of TB disease. Radiographs are usually normal but may show evidence of healed primary complex in the form of dense nodules (with or without calcifications), calcified nonenlarged regional lymph nodes, or pleural thickening [16], [17]. CT scans are generally not indicated in children with LTBI unless a chest radiograph is equivocal.

Diagnosis of pediatric latent tuberculosis infection and tuberculosis

The diagnosis of TB infection or disease rests on the basic components of history (eg, previous TB or contact with infectious case, signs, and symptoms), TST results including the precise millimeters of induration, chest or other radiographic findings, and mycobacteriology smear and culture results. LTBI is relatively simple to diagnose in children. Criteria for diagnosis are

  • A positive TST as interpreted based on stratification of risk factors (Box 1)

  • Normal chest radiograph or radiographic

Treatment of latent tuberculosis infection and tuberculosis disease

Children with LTBI and TB are treated with the drugs used for adults, although regimens, side-effect profiles, and availability of antituberculous drugs in pediatric doses may differ. Further, recommendations for pediatric regimens and doses from national and international organizations (eg, the British Thoracic Society, American Thoracic Society, WHO) may differ. Nevertheless, the backbone of all recommended regimens for LTBI is isoniazid unless the child has been exposed to an

Public health aspects of pediatric tuberculosis

As with adults, the public health sector plays an important role in control of TB in children through a hierarchy of activities that range from identification and treatment of patients with TB disease to conducting public health investigations of infectious source cases and identifying and treating patients with LTBI [19]. Following recognition of an infectious adult or adolescent case, a contact investigation is performed to identify exposed persons, including children and adolescents, and

Summary

The epidemiology of pediatric TB continues to be shaped by risk factors such as age, race, immigration, poverty, overcrowding, and HIV/AIDS. Once infected, young children have an increased risk of TB disease and progression to extrapulmonary disease because of immunologic host factors. The pathogenesis of disease differs from that in adults, because primary disease and its complications are more common in children. This prevalence of primary disease in turn leads to differences in clinical and

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References (81)

  • L.J. Nelson et al.

    Global epidemiology of childhood tuberculosis

    Int J Tuberc Lung Dis

    (2004)
  • X.T. Ussery et al.

    Epidemiology of tuberculosis among children in the United States: 1985 to 1994

    Pediatr Infect Dis J

    (1996)
  • L.J. Nelson et al.

    Epidemiology of childhood tuberculosis in the United States, 1993–2001: the need for continued vigilance

    Pediatrics

    (2004)
  • M.N. Lobato et al.

    Mycobacterium tuberculosis infection after travel to or contact with visitors from countries with a high prevalence of tuberculosis

    Am J Respir Crit Care Med

    (1998)
  • L. Saiman et al.

    Risk factors for latent tuberculosis infection among children in New York City

    Pediatrics

    (2001)
  • R.E. Besser et al.

    Risk factors for positive Mantoux tuberculin skin tests in children in San Diego, California: evidence for boosting and possible foodborne transmission

    Pediatrics

    (2001)
  • H. Froehlich et al.

    Targeted testing of children for tuberculosis: validation of a risk assessment questionnaire

    Pediatrics

    (2001)
  • Core curriculum on tuberculosis

    (2000)
  • E.M. Lincoln et al.

    Tuberculosis in children

    (1963)
  • Diagnostic standards and classification of tuberculosis in adults and children

    Am J Respir Crit Care Med

    (2000)
  • D.A. Lewinsohn et al.

    Tuberculosis immunology in children: diagnostic and therapeutic challenges and opportunities

    Int J Tuberc Lung Dis

    (2004)
  • Targeted tuberculin testing and treatment of latent tuberculosis infection

    Am J Respir Crit Care Med

    (2000)
  • Tuberculosis

  • N.A. Smuts et al.

    Value of the lateral chest radiograph in tuberculosis in children

    Pediatr Radiol

    (1994)
  • Targeted tuberculin skin testing and treatment of latent tuberculosis infection in children and adolescents

    Pediatrics

    (2004)
  • J.R. Starke et al.

    Tuberculosis in the pediatric population of Houston, Texas

    Pediatrics

    (1989)
  • E.A. Khan et al.

    Diagnosis of tuberculosis in children: increased need for better methods

    Emerg Infect Dis

    (1995)
  • I. Sanchez-Albisua et al.

    Twenty years of pulmonary tuberculosis in children: what has changed?

    Pediatr Infect Dis J

    (2002)
  • H.C. Maltezou et al.

    Extra-pulmonary tuberculosis in children

    Arch Dis Child

    (2000)
  • A. Wallgren

    The time table of tuberculosis

    Tubercle

    (1948)
  • F. van den Bos et al.

    Tuberculous meningitis and miliary tuberculosis in young children

    Trop Med Int Health

    (2004)
  • N.J. Waecker et al.

    Central nervous system tuberculosis in children: a review of 30 cases

    Pediatr Infect Dis J

    (1990)
  • G. Delage et al.

    Tuberculous meningitis in children: a retrospective study of 79 patients, with analysis of prognostic factors

    Can Med Assoc J

    (1979)
  • G. Hussey et al.

    Miliary tuberculosis in children: a review of 94 cases

    Pediatr Infect Dis J

    (1991)
  • F.M. Munoz et al.

    Tuberculosis in children

  • J.G. Vallejo et al.

    Tuberculous osteomyelitis of the long bones in children

    Pediatr Infect Dis J

    (1995)
  • H.E. Teo et al.

    Skeletal tuberculosis in children

    Pediatr Radiol

    (2004)
  • P. Ormerod

    Tuberculosis in pregnancy and the puerperium

    Thorax

    (2001)
  • R. Figueroa-Damian et al.

    Pregnancy and tuberculosis: influence of treatment on perinatal outcome

    Am J Perinatol

    (1998)
  • N. Jana et al.

    Obstetrical outcomes among women with extrapulmonary tuberculosis

    N Engl J Med

    (1999)
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