Pediatric tuberculosis: new guidelines and recommendations.

ABSTRACT

PURPOSE OF REVIEW To discuss the recommendations pertaining to infants, children, and adolescents in new and updated tuberculosis (TB) guidelines that have been published since 2010 - with emphasis on those from supranational organizations. RECENT FINDINGS: The main developments in the guidelines covered in this article are related to novel diagnostics for TB infection, disease, and drug resistance; updated treatment regimens for childhood and drug-resistant TB (DR-TB); and primary and secondary prevention of TB disease in HIV-infected children and adolescents. SUMMARY: These new guidelines have significant implications for improving pediatric TB care. Regarding diagnosis, current interferon-gamma release assays should not replace tuberculin skin testing, but may be complementary; a polymerase chain reaction assay has been validated for detecting Mycobacterium tuberculosis and rifampicin resistance in microscopy-negative samples, especially in HIV-infected and DR-TB suspects; and a molecular line probe assay has been validated for detecting DR-TB in microscopy-positive samples and culture isolates in DR-TB suspects. With respect to treatment, there have been certain changes in the recent World Health Organization recommendations for certain clinical syndromes, for multidrug-resistant TB disease, and for HIV/TB disease. Concerning prevention, there are new screening algorithms for case finding, and new recommendations for treating HIV-infected children with presumed TB infection and with TB disease with treatment completed (i.e., secondary prophylaxis).