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Poor surveillance in international settings, especially resource-poor high-burden settings, due largely to health system barriers, variations in case definitions and difficulty in diagnosis, and standardization and reporting, lead to an underdetected epidemic of childhood tuberculosis (TB).
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Considerable progress has been made in consolidated guidelines on appropriate dosing and safe and effective regimens for treating childhood TB. However, gaps in implementing treatment completion in
Updates in Pediatric Tuberculosis in International Settings
Section snippets
Key points
Epidemiology of pediatric tuberculosis in international settings
TB continues to afflict several populations across the globe in different socioeconomic settings. The highest burden of disease is typically seen in countries with weakened health systems,3,4 which characteristically also marginalize vulnerable pediatric populations. Prevention of spread and control as well as adequate individual management of TB therefore requires political will and a strategic system approach, with ambitious targets and rigorous monitoring and evaluation framework.
Updates in pediatric tuberculosis case detection and diagnosis
Diagnosis of pediatric TB may be made based on bacteriologic testing, clinical criteria, or a combination of supportive evidence provided by biomarkers and radiological imaging. Despite advances in each of these, diagnosis of pediatric TB remains difficult in clinical settings.
Treatment of Drug-Susceptible Tuberculosis in Children
TB disease in children has traditionally been treated with the agents used to treat adult disease. First-line regimens for drug-susceptible TB across the world still contain isoniazid, rifampin, ethambutol, and pyrazinamide. Dosages have recently been increased by WHO41,42 with 2 months of rifampicin (R) (10–20 mg/kg, maximum [max] dose 600 mg/d), pyrazinamide (Z) (30–40 mg/kg), isoniazid (H) (10–15 mg/kg, max dose 300 mg/d), and sometimes ethambutol (E) (15–25 mg/kg, in areas of high HIV or
Human Immunodeficiency Virus and Tuberculosis
HIV-infected children are at high risk of acquiring and developing TB after exposure. These children require immediate preventive therapy after exclusion of active disease, irrespective of age and immune status. Although preventive therapy should be provided at each TB exposure, continuous isoniazid prophylaxis is not recommended.
For all patients with HIV and drug-susceptible TB, antiretrovirals should be started regardless of their CD4 cell count; however, TB treatment should be initiated
Preventive Therapy
Contact investigation is not routinely implemented in most HBCs. Case finding is passive at best with very little community engagement or empowerment of first-line health professionals108; this leads indirectly to poor coverage rates of preventive treatment to children. In 2017, preventive therapy was not accessed by more than 75% of 1.3 million eligible household contacts younger than 5 years of age. There is a need to address persistent policy-practice gaps in screening children for TB
Clinics care points
When biopsying tissue for histopathological diagnosis of suspected exptrapulmonary TB (EPTB) in LMICs, it should be ensured that tissue (lymph node, bone marrow, skin lesions refractory to standard treatment, lumps/masses) is sent for Xpert and/or AFB culture to avoid missing nontuberculous mycobacterial infections, fungal infection, and lymphoma (TB mimics). TB should be part of most chronic presentations by default because it can have atypical presentations in endemic HBCs such as isolated
Disclosure
The authors have nothing to disclose.
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