Tuberculosis in children – from diagnostics to chemoprophylaxis and treatment

Abstract

Tuberculosis is a disease known to the mankind for centuries, but still poses a big social problem and a challenge for the twenty-first century medicine. It is estimated that at least 30% of the global population is infected with the tubercle bacillus. The disease develops in 9 million people annually, including 1 million children aged below 15. Tuberculosis in the paediatric population requires particular attention because the incidence in this age group is a measure of the epidemiological situation of tuberculosis in a given area. Diagnosis of tuberculosis in children is particularly difficult due to its sparse and non-specific symptoms, imitating other diseases and increasing number of cases of mycobacterial infection without clinical, radiological and microbiological symptoms – so-called latent tuberculosis. If conditions are favourable, latent mycobacterial infection may develop into an active disease and therefore the authors draw attention to the need for rapid diagnosis of infection with Mycobacterium tuberculosis and describe the existing diagnostic methods (tuberculin skin test, interferon-gamma release assays) as well as indications for chemoprophylaxis and principles of conducting it in children. Moreover, the authors also emphasise the necessity for a thorough interview and physical examination, analysis of sputum-positive patient’s contacts, imaging and microbiological tests as well as a significant role of family physicians and paediatricians. Due to the growing phenomenon of resistance of mycobacteria to different drugs (according to the WHO, the general number of new cases of MDR-TB and XDR-TB diagnosed in 2012 amounts to 450 thousand), the issue of multidrug-resistant tuberculosis as well as its treatment and available medications are discussed.

Keywords

• tuberculosis in children
• latent tuberculosis
• multidrug-resistant tuberculosis
• IGRA tests
• BCG vaccine