Tuberculosis in Children

Peter J. Holmberg; Zelalem Temesgen; Ritu Banerjee

doi:10.1542/pir.2018-0093

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Clarification - June 01, 2019

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Peter J. Holmberg, MD*
Zelalem Temesgen, MD^†
Ritu Banerjee, MD, PhD^‡

^*Division of Pediatric Hospital Medicine, Department of General Pediatric and Adolescent Medicine, and
^†Division of Infectious Disease, Mayo Clinic, Rochester, MN
^‡Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN

AUTHOR DISCLOSURE
Drs Holmberg and Temesgen have disclosed no financial relationships relevant to this article. Dr Banerjee has disclosed that she receives research funding from bioMérieux, BioFire, and Accelerate Diagnostics. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

BCG:: Bacille Calmette-Guérin
CDC:: Centers for Disease Control and Prevention
CXR:: chest radiograph
DOT:: directly observed therapy
EMB:: ethambutol
FDA:: Food and Drug Administration
HIV:: human immunodeficiency virus
IGRA:: interferon-γ release assay
INH:: isoniazid
LTBI:: latent tuberculosis infection
Mtb:: Mycobacterium tuberculosis
NTM:: nontuberculous mycobacteria
RIF:: rifampin
PZA:: pyrazinamide
TB:: tuberculosis
TST:: tuberculin skin test

Practice Gaps

Although tuberculosis (TB) is an ancient disease, it continues to cause significant morbidity and mortality throughout the world, including among children. Knowledge of appropriate TB screening, diagnostic testing, and treatment recommendations is of vital importance for primary care providers when caring for children at high risk for TB.

Objectives

After completing this article, readers should be able to:

Understand the epidemiology of pediatric tuberculosis (TB).
Describe the mechanisms of TB acquisition and host response, including T-cell–mediated actions and granuloma formation.
Discuss the importance of comorbid conditions, specifically human immunodeficiency virus type 1, on the acquisition and progression of TB disease.
Identify risk factors for acquisition of TB infection.
Recognize the utility of tests for latent TB infection (LTBI), including the tuberculin skin test, interferon-γ release assays, and the effect of age and Bacille Calmette-Guérin vaccination status on interpretation of results.
Define the differences among TB, multidrug-resistant TB, and extensively drug-resistant TB.
Understand the principles of therapy and drug regimens for LTBI and TB disease (including drug-resistant TB).

Introduction

One of the most common infectious diseases worldwide, tuberculosis (TB) is estimated to affect almost 1 in 3 individuals across the globe. Despite relatively cheap and accurate diagnostic assays as well as established effective treatment regimens, TB remains a leading cause of death annually. When diagnosed and appropriately treated, TB mortality in children approaches zero. However, with an estimated yearly burden of 1 million new pediatric cases worldwide and most of these remaining undiagnosed, TB continues to pose a substantial threat to global child health. Furthermore, most pediatric infections …