Management of children exposed to a patient with tuberculosis
Abstract
Background: The article presents diagnostic and therapeutic recommendations for children, who have been exposed to a person with contagious tuberculosis. We stress the importance of recognition and treatment of latent tuberculosis infection which substantially reduces the risk of progression to tuberculosis disease. Children exhibit few clinical signs and symptoms which are rarely specific enough to indicate the tuberculous disease. Intrathoracic tuberculosis is frequently silent in its early stages. In contrast to adults, bacteriological confirmation is relatively infrequent in children and the diagnosis is based on the analyses of chest radiograph, tuberculin skin test and contact with tuberculous patient. Most of the radiographic manifestations reflect the compression of major airways by enlarged lymph nodes.
Conclusions: Because the incubation period of disseminated tuberculosis in young children can be very short, children exposed to adults with pulmonary tuberculosis should be investigated without delay. Any delay in diagnosis and therefore treatment, may lead to severe and even life-threating complications.
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References
Eržen D, Žolnir-Dovč M, Šorli J. Analiza epidemije tuberkuloze 2003 in učinkovitosti zdravljenja 2002. 9. redni posvet o obravnavi in spremljanju bolnikov s tuberkulozo. Bolnišnica Golnik – Klinični oddelek za pljučne bolezni in alergijo; 2004. Mar 24; Golnik, Slovenija.
Kopriva S. Tuberkuloza v Sloveniji pri otrocih in mladostnikih v začetku tretjega tisočletja. Izbrana poglavja iz Pediatrije. Tuberkuloza. Zbornik predavanj. Ljubljana: Pediatrična klinika; 2002: 9–18.
Borinc-Beden A. Analiza pediatrične tuberkuloze v Sloveniji in izvajanje preventivnega zdravljenja latentne okužbe s tuberkulozo pri otrocih in mladostnikih. 9. redni posvet o obravnavi in spremljanju bolnikov s tuberkulozo. Bolnišnica Golnik – Klinični oddelek za pljučne bolezni in alergijo; 2004. Mar 24; Golnik, Slovenija.
Šorli J. Ukinitev neselektivnega cepljenja z BCG ob rojstvu. 9. redni posvet o obravnavi in spremljanju bolnikov s tuberkulozo. Bolnišnica Golnik – Klinični oddelek za pljučne bolezni in alergijo; 2004. Mar 24; Golnik, Slovenija.
Borinc-Beden A, Kopriva S, Maček V. 10. redni posvet o obravnavi in spremljanju bolnikov s tuberkulozo. Strokovna izhodišča za iskanje vira pri otrocih s tuberkulozo. Bolnišnica Golnik – Klinični oddelek za pljučne bolezni in alergijo; 2005. Mar 24; Golnik, Slovenija.
International Union Against Tuberculosis and Lung Disease. Criteria for discontinuation of vaccination programmes using bacille Calmette-Guerin (BCG) in countries with low prevalence of tuberculosis. Tuber Lung Dis 1994; 75: 179–80.
Romanus V. The impact of BCG vaccination on mycobacterial disease among children born in Sweden between 1969 and 1993. [Dissertation.] Stockholm: Karolinska Institutet and Smittskyddsinstitutet; 1995.
Trnka L, Dankova D, Svandova E. Six years experience with the discontinuation of BCG vaccination: 2 cost and benefit of mass BCG vaccination. Tuber Lung Dis 1993; 74: 288–92.
Connely Smith K, Starke JR, Eisenach K, Ong LT, Denby M. Detection of M. tuberculosis in clinical specimens from children using a polymerase chain reaction. Pediatrics 1996; 97: 155–60.
American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000; 161: 1376–95.
Correa AG. Unique aspects of tuberculosis in the pediatric population. Clin Chest Med 1997; 18: 89–98.
Batra V. Tuberculosis. Emedicine Nov 2004. Dosegljivo na: emedicine.com
Riley RL, Moodie AS. Infectivity of patients with pulmonary tuberculosis in innercity homes. Am Rev Repir Dis 1974; 110: 810–2.
Connolly MA, Chaulet P, Raviglione MC. Epidemiology of tuberculosis. In: Wilson R, ed. Tuberculosis. Eur Resp Mon 1997; 2: 51–67, 144–74, 327–53.
Inselman L. Tuberculosis in children. Pediatr Pulmonol 1996; 21: 101–20.
Starke JR, Correa AG. Management of mycobacterial infection and disease in children. Pediatr Infect Dis J 1995; 14: 455–70.
Ormerod LP. Reduced incidence of tuberculosis by prophylactic chemotherapy in subjects showing strong reactions to tuberculin testing. Arch Dis Child 1987; 82: 1005–8.
American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000; 161: S221–47.
Pediatric tuberculosis collaborative group. Targeted tuberculin skin testing and treatment of latent tuberculosis infection in children and adolescent. Pediatrics 2004; 114: S1175–201.
Maček V. Otrok, ki je bil v stiku s tuberkuloznim bolnikom – algoritem obravnave v otroškem in šolskem dispanzerju. Izbrana poglavja iz Pediatrije. Tuberkuloza. Zbornik predavanj. Ljubljana: Pediatrična klinika; 2002. p. 19–22.
Maček V. Klinična slika in diagnosticiranje tuberkuloze pri otroku. Slov Pediatr 1998; 5: 50–6.
Anon. Chemotherapy and Management of tuberculosis in the United Kingdom: recommendations. Thorax 1998; 53: 536–48.
Anon. Control and prevention of tuberculosis in the United Kingdom: Code of Practice. Thorax 2000; 55: 887–901.
American Thoracic Society and the Centers for Disease Control and Prevention. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994; 149: 1359–74.
Ormerod LP. Rifampicin and isoniazid prophylactic chemotherapy for tuberculosis. Arch Dis Child 1998; 78: 169–71.
Jasmer RM, Nahid P, Hopewell PC. Latent tuberculosis infection. N Engl J Med 2002; 347: 1860–6.
Eržen D, Zalokar P, Žolnir-Dovč M, Šorli J. Organizacija obravnave otrok in mladostnikov, ki so bili v stiku z odraslimi tuberkuloznimi bolniki. Izbrana poglavja iz Pediatrije. Tuberkuloza. Zbornik predavanj. Ljubljana: Pediatrična klinika; 2002. p. 29–33.
Kopriva S. Zdravljenje tuberkuloze pri otrocih. Slov Pediatr 1998; 5: 64–7.
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