Recently, epidemiological data shows an increase of childhood tuberculosis in Germany. In addition to this, drug resistant tuberculosis becomes more frequent. Therefore, diagnosis, prevention and therapy in childhood and adolescence remain a challenge. Adult guidelines do not work for children, as there are age specific differences in manifestation, risk of progression and diagnostic as well as therapeutic pathways.The German Society for Pediatric Infectious Diseases (DGPI) has initiated a consensus-based (S2k) process and completed a paediatric guideline in order to improve and standardize care for children and adolescents with tuberculosis exposure, infection or disease.Updated dosage recommendations take age dependant pharmacokinetics in the treatment of drug sensitive but also drug resistant tuberculosis in account. In addition to this, there is a detailed chapter on perinatal exposure and disease as well as extrapulmonary manifestations.
Counselors and caregivers should be aware of the adverse effects of premastication. Education should include advice to avoid premastication and to seek health advice for oral conditions in the caregiver and child. More studies are needed to better define the extent and risks of premastication, including its possible role in increasing HIV-1 transmission.
Background
Identifying a source case for TB-exposed children is challenging. We examined the timepoint of obtaining source case TB contact information in HIV-infected and HIV-exposed uninfected (HEU) children in a randomized, placebo-controlled trial of pre-exposure isoniazid prophylaxis.
Methods
543 HIV-infected and 808 HEU infants without TB exposure between 3 and 4 months of age were enrolled between 2004 and 2008. At 3 monthly follow-up, infants were evaluated for TB and caregivers were asked about new TB exposures.
Results
128 cases of TB disease and 40 deaths were recorded, 19% (105/543) for HIV-infected and 8% (63/808) for HEU, 229 TB contact occasions were reported in 205/1351 (15%), (83%: 189/229) in the household. 53% of household contacts (108/189) had microbiological evaluations, 81% (87/108) were positive. HIV-infected and HEU infants had similar frequencies of TB contacts, reported in 48% with definite TB, 58% for probable TB, 43% for possible TB. Among 128 children diagnosed with TB, a TB contact was identified for 59. Of these, 29/59 (49%) were identified at or after child’s TB diagnosis.
Conclusion
TB source cases are often identified at or after a child’s TB diagnosis. More effort is required for earlier detection.
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