Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지

Korean Guidelines for Diagnosis and Treatment of Tuberculosis in Children and Adolescents

소아청소년 결핵의 진료 지침

  • Choi, Kyong Min (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Kim, Nam Hee (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Kim, Dong-Ho (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Kim, Yae Jean (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Kim, Jong-Hyun (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Oh, Sung Hee (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Eun, Byung Wook (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Lee, Soo-Young (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Lee, Taek Jin (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Chun, Jin-Kyong (Joint Committee for the Development of Korean Guidelines for Tuberculosis) ;
  • Hong, Jung Yun (Joint Committee for the Development of Korean Guidelines for Tuberculosis)
  • 최경민 (결핵진료지침 개발위원회) ;
  • 김남희 (결핵진료지침 개발위원회) ;
  • 김동호 (결핵진료지침 개발위원회) ;
  • 김예진 (결핵진료지침 개발위원회) ;
  • 김종현 (결핵진료지침 개발위원회) ;
  • 오성희 (결핵진료지침 개발위원회) ;
  • 은병욱 (결핵진료지침 개발위원회) ;
  • 이수영 (결핵진료지침 개발위원회) ;
  • 이택진 (결핵진료지침 개발위원회) ;
  • 전진경 (결핵진료지침 개발위원회) ;
  • 홍정연 (결핵진료지침 개발위원회)
  • Received : 2011.06.02
  • Accepted : 2011.06.03
  • Published : 2011.06.25
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Abstract

Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.

Keywords

Acknowledgement

Supported by : 국민건강증진기금

References

  1. Marais BJ, Gie RP, Schaaf HS, Beyers N, Donald PR, Starke JR. Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med 2006;173:1078-90. https://doi.org/10.1164/rccm.200511-1809SO
  2. Starke JR. New concepts in childhood tuberculosis. Curr Opin Pediatr 2007;19:306-13. https://doi.org/10.1097/MOP.0b013e32814b164a
  3. Agrons GA, Markowitz RI, Kramer SS. Pulmonary tuberculosis in children. Semin Roentgenol 1993;28:158-72. https://doi.org/10.1016/S0037-198X(05)80105-1
  4. Lamont AC, Cremin BJ, Pelteret RM. Radiological patterns of pulmonary tuberculosis in the paediatric age group. Pediatr Radiol 1986;16:2-7. https://doi.org/10.1007/BF02387495
  5. Gillman A, Berggren I, Bergstrpom SE, Wahlgren H, Bennet R. Primary tuberculosis infection in 35 children at a Swedish day care center. Pediatr Infect Dis J 2008;27:1078-82. https://doi.org/10.1097/INF.0b013e31817e83f4
  6. Andronikou S, Joseph E, Lucas S, Brachmeyer S, Du Toit G, Zar H, et al. CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children. Pediatr Radiol 2004;34:232-6. https://doi.org/10.1007/s00247-003-1117-0
  7. de Charnace G, Delacourt C. Diagnostic techniques in paediatric tuberculosis. Paediatr Respir Rev 2001;2:120-6. https://doi.org/10.1053/prrv.2000.0119
  8. Kim WS, Moon WK, Kim IO, Lee HJ, Im JG, Yeon KM, et al. Pulmonary tuberculosis in children: evaluation with CT. AJR Am J Roentgenol 1997;168:1005-9. https://doi.org/10.2214/ajr.168.4.9124105
  9. Carr DT, Karlson AG, Stilwell GG. A comparison of cultures of induced sputum and gastric washings in the diagnosis of tuberculosis. Mayo Clin Proc 1967;42:23-5.
  10. Shata AM, Coulter JB, Parry CM, Ching'ani G, Broadhead RL, Hart CA. Sputum induction for the diagnosis of tuberculosis. Arch Dis Child 1996;74:535-7. https://doi.org/10.1136/adc.74.6.535
  11. Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005;365:130-4. https://doi.org/10.1016/S0140-6736(05)17702-2
  12. Iriso R, Mudido PM, Karamagi C, Whalen C. The diagnosis of childhood tuberculosis in an HIV-endemic setting and the use of induced sputum. Int J Tuberc Lung Dis 2005;9:716-26.
  13. Vallejo JG, Ong LT, Starke JR. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics 1994;94:1-7.
  14. Burroughs M, Beitel A, Kawamura A, Revai K, Ricafort R, Chiu K, et al. Clinical presentation of tuberculosis in culture-positive children. Pediatric Tuberculosis Consortium. Pediatr Infect Dis J 1999;18:440-6. https://doi.org/10.1097/00006454-199905000-00008
  15. Noordhoek GT, Kolk AH, Bjune G, Catty D, Dale JW, Fine PE, et al. Sensitivity and specificity of PCR for detection of Mycobacterium tuberculosis: a blind comparison study among seven laboratories. J Clin Microbiol 1994;32:277-84.
  16. Montenegro SH, Gilman RH, Sheen P, Cama R, Caviedes L, Hopper T, et al. Improved detection of Mycobacterium tuberculosis in Peruvian children by use of a heminested IS6110 polymerase chain reaction assay. Clin Infect Dis 2003;36:16-23. https://doi.org/10.1086/344900
  17. Gomez-Pastrana D, Torronteras R, Caro P, Anguita ML, Lopez-Barrio AM, Andres A, et al. Comparison of amplicor, in-house polymerase chain reaction, and conventional culture for the diagnosis of tuberculosis in children. Clin Infect Dis 2001;32:17-22. https://doi.org/10.1086/317526
  18. World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children. (WHO/HTM/TB/2006.371) 2006.
  19. RedbookOnline. http://aapredbook.aappublications.org/cgi/content/full/2009/1/3.144?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=tuberculosis&searchid=1&FIRSTINDEX=0&fdate=1/1/2009&tdate=1/31/2009&resourcetype=HWCIT. 2009.
  20. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. (WHO/HTM/TB/2006.361) 2006.
  21. Smith KC, Seaworth BJ. Drug-resistant tuberculosis: controversies and challenges in pediatrics. Expert Rev Anti Infect Ther 2005;3:995-1010. https://doi.org/10.1586/14787210.3.6.995
  22. Cruz AT, Starke JR. Treatment of tuberculosis in children. Expert Rev Anti Infect Ther 2008;6:939-57. https://doi.org/10.1586/14787210.6.6.939
  23. World Health Organization. Ethambutol efficacy and toxicity. Literature review and recommendations for daily and intermittent dosage in children. (WHO/HTM/TB/2006.365) 2006.
  24. Ellner JJ. Review: the immune response in human tuberculosis--implications for tuberculosis control. J Infect Dis 1997;176:1351-9. https://doi.org/10.1086/514132
  25. Rigaud M, Borkowsky W. Tuberculosis in children. In : Rom WN, Garay SM, eds. Tuberculosis. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins Co, 2004: 607-24.
  26. Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004;8:392-402.
  27. Pediatrics AAo. Tuberculosis. In : Pickering LK, Baker CJ, Long SS, and McMillan JA, editors. 2009.
  28. Mazurek M, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep 2010;59:1-25.
  29. Lewinsohn DA, Lobato MN, Jereb JA. Interferon-gamma release assays: new diagnostic tests for Mycobacterium tuberculosis infection, and their use in children. Curr Opin Pediatr 2010;22:71-6. https://doi.org/10.1097/MOP.0b013e3283350301
  30. Long R, Ellis E. Canadian tuberculosis standards. 6th eds 2007.
  31. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006;10:1192-204.
  32. Ena J, Valls V. Short-course therapy with rifampin plus isoniazid, compared with standard therapy with isoniazid, for latent tuberculosis infection: a meta-analysis. Clin Infect Dis 2005;40:670-6. https://doi.org/10.1086/427802