Tuberculosis Infection in Children and Adolescents

Youngui, Boris Tchakounte; Tchounga, Boris; Graham, Stephen M.; Bonnet, Maryline

doi:10.3390/pathogens11121512

Cited by 8 publications

(3 citation statements)

References 99 publications

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“…False-positive TST results can be influenced by factors such as prior Bacillus Calmette-Guerin vaccination, errors in TST administration or interpretation, and exposure to non-tuberculous mycobacteria. 23 24 Physician’s uncertainty regarding a positive TST result and their failure to reinforce treatment completion may have possibly occurred. In previous studies, concerns expressed by parents or patients about potential side effects have been reported as potential barriers in LTBI treatment.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Kim,

Bae,

Choi

et al. 2024

J Korean Med Sci

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Background The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data. Methods We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician’s specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion. Results Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018–2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20–2.66; P < 0.001). Additionally, management in a primary hospital, a hospital’s location in a non-metropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion. Conclusion Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.

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Section: Discussionmentioning

confidence: 99%

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Kim,

Bae,

Choi

et al. 2024

J Korean Med Sci

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“…Signs and symptoms that can guide the diagnosis are reported in Table 3. The simultaneity of some symptoms, such as persistent cough, listlessness and weight loss, have a predictive value in 80% of children with pulmonary TB [11,68].…”

Section: Anamnesismentioning

confidence: 99%

“…In these cases, there is a 10% risk of reactivation in adulthood. In addition, in children, the disease has some peculiarities that differentiate it from the adult forms [ 10 , 11 , 12 ]. These features are paucibacillary; a low incidence of cavitary forms; an increased frequency in evolution of the infection into the disease; a more rapid and severe course in children < 2 years; a high incidence of extrapulmonary forms; in 20–60% of cases it can be symptomatic; radiology is often of little significance; and diagnostic difficulties.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Tuberculosis in Children: A Forgotten Disease?

Pelosi¹,

Pintus

Savasta

et al. 2023

Microorganisms

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Even today, tuberculosis in childhood is a disease that is often undiagnosed and undertreated. In the absence of therapy with antituberculosis drugs, children in the first years of life have a high degree of severe forms and mortality. In these children, symptoms are often not very specific and can easily be confused with other diseases of bacterial, viral or fungal etiology, making diagnosis more difficult. Nevertheless, the introduction of new diagnostic techniques has allowed a more rapid identification of the infection. Indeed, Interferon gamma release assay (IGRA) is preferred to the Mantoux, albeit with obvious limitations in children aged <2 years. While the Xpert Mtb/RIF Ultra test is recommended as an initial diagnostic investigation of the gastric aspirate and/or stools in children with signs and symptoms of pulmonary tuberculosis. The drugs used in the treatment of susceptible and resistant TB are the same as those used in adults but doses and combinations are different in the pediatric age. In children, brief therapy is preferable in both the latent infection and the active disease, as a significant reduction in side effects is obtained.

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The impact of screening for tuberculosis exposure in the household in children with tuberculosis disease: A difficult riddle to solve

Ozbakir,

Guner Ozenen,

Ergun

et al. 2024

Pediatric Pulmonology

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BackgroundTuberculosis (TB) infection is transmitted by sharing the same airway with people with active TB. Children are often not considered the source of TB bacilli, and index case investigation is carried out after diagnosis. Here, we describe the impact of the presence of a household index case on childhood TB disease.MethodsThe data of patients aged between 1 month and 18 years who were diagnosed with TB were collected. We compared patients according to whether they had an index case in the household or not.ResultsA total of 202 TB patients were enrolled, of whom 62 (30.7%) had a household index case. There was no significant difference in having a household index case between TB patients under the age of five (23.3%) and older children (33.8%) (p = .140). Pulmonary TB was present in 61.4% of the cases, and extrapulmonary TB was present in 38.6% of the cases. The rate of patients who had a household index case was significantly higher in pulmonary TB (46.8%) compared to extrapulmonary TB (5.1%) (p < .001). Pulmonary TB patients with a history of household contact were more likely to have diagnostic radiological findings (93.1%) compared to those without (75.8%) (p = .009). However, pulmonary TB patients without household contact history had a higher rate of diagnostic microbiological findings (59.1%) and constitutional symptoms (63.6%) (p = .019 and p = .013, respectively).ConclusionHousehold contact research is an important epidemiological tool. However, considering the contact rates in the household, new and more comprehensive public health programs are required to prevent the spread of childhood tuberculosis.

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Tuberculosis Infection in Children and Adolescents

Cited by 8 publications

References 99 publications

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

Pulmonary Tuberculosis in Children: A Forgotten Disease?

The impact of screening for tuberculosis exposure in the household in children with tuberculosis disease: A difficult riddle to solve

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