Latent tuberculosis infection in children
- Lisa V Adams, MD
Lisa V Adams, MD
- Associate Professor
- Geisel School of Medicine at Dartmouth
- Jeffrey R Starke, MD
Jeffrey R Starke, MD
- Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- C Fordham von Reyn, MD
C Fordham von Reyn, MD
- Section Editor — Tuberculosis; Nontuberculous Mycobacterial Infections
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Identification and treatment of children with latent tuberculosis infection (LTBI) has become an important component of tuberculosis (TB) control efforts in low-incidence countries such as the United States. The goals of TB screening programs are case finding and treatment of TB disease, identification and treatment of latent infection to prevent development of disease, and decreased transmission.
Most children identified with LTBI have been infected relatively recently compared with adults who may have been infected decades previously (especially those younger than age five years). Children and adolescents are at higher risk for progression from infection to TB disease (with potential for disseminated disease) than adults . Children under two to four years of age are the highest risk of progression with development of disseminated and central nervous system tuberculosis . Most cases of progression to TB disease in children occur within 2 to 12 months of initial infection . (See "Natural history, microbiology, and pathogenesis of tuberculosis".)
Issues related to diagnosis and treatment of LTBI in children will be reviewed here. Issues related to treatment of TB disease in children are discussed in detail separately. (See "Tuberculosis disease in children".)
Whom to test
Overview — In countries with low incidence of tuberculosis (TB) and with sufficient resources (such as the United States), testing for latent tuberculosis infection (LTBI) in children should be targeted to specific groups at risk for LTBI and/or progression to TB disease [4,5]. Only children who would benefit from treatment should be tested, so a decision to test presupposes a decision to treat if the test is positive.
In general, testing for LTBI is warranted to identify individuals who are at risk of new infection and to identify individuals at increased risk of reactivation due to associated conditions [6,7]. A questionnaire developed by the Pediatric Tuberculosis Collaborative Group can be used to screen children in a variety of clinical settings (form 1) . Among children, the major risk factor for TB infection is contact with patients who have TB disease, either due to household exposure or residence in a region where TB is endemic (table 1). Identification of a child with a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) should prompt testing of the other children in the household as well as investigation for the index source case.
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- Whom to test
- - Overview
- - Case contacts
- - Foreign-born children
- How to test
- - Tuberculin skin test
- - Interferon-gamma release assays
- RULING OUT TUBERCULOSIS DISEASE
- TREATMENT REGIMENS
- Susceptible organisms
- - Isoniazid
- - Isoniazid and rifapentine
- - Rifampin
- Drug-resistant organisms
- SUBSEQUENT MANAGEMENT
- SUMMARY AND RECOMMENDATIONS