Recommendations Concerning the Therapeutic Approach to Immunocompromised Children With Tuberculosis

This article describes the recommendations of a group of scientific societies concerning the therapeutic approach to immunocompromised children with tuberculosis (TB). Using the Consensus Conference method, relevant publications in English were identified by a systematic review of MEDLINE and the Co...

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Bibliographic Details
Published in:Clinical therapeutics Vol. 38; no. 1; pp. 180 - 190
Main Authors: Lancella, Laura, Galli, Luisa, Chiappini, Elena, Montagnani, Carlotta, Gabiano, Clara, Garazzino, Silvia, Principi, Nicola, Tadolini, Marina, Matteelli, Alberto, Battista Migliori, Giovanni, Villani, Alberto, de Martino, Maurizio, Esposito, Susanna
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.01.2016
Subjects:
Adolescent
Antitubercular Agents - therapeutic use
Child
Child, Preschool
children
Coinfection - drug therapy
Consensus
Delphi Technique
Drug Therapy, Combination
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - immunology
Humans
Immunocompromised Host
immunodeficiency
immunosuppressants
Infant
Infant, Newborn
Internal Medicine
Medical Education
Mycobacterium
tuberculosis
Tuberculosis, Pulmonary - complications
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - drug therapy
immunodeficiency
HIV
children
immunosuppressants
TB
tuberculosis
ISSN:0149-2918, 1879-114X, 1879-114X
Online Access:Get full text
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Summary:This article describes the recommendations of a group of scientific societies concerning the therapeutic approach to immunocompromised children with tuberculosis (TB). Using the Consensus Conference method, relevant publications in English were identified by a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until December 31, 2014. On the basis of their clinical experience and the published evidence, the group of experts concluded that, although immunosuppressed subjects are at greater risk of developing TB, none of the signs or symptoms is sensitive or specific enough to enable a diagnosis. Immunocompromised patients are at greater risk of developing extrapulmonary forms of TB, especially if they are adolescents, whereas pulmonary forms are more prevalent among younger patients. When TB is suspected, a combination of skin and immunologic tests and other clinical, radiologic, and microbiologic examinations can be used to assess the risk of infection or disease. If the TB diagnosis is confirmed, immunocompromised children should be treated by using a standard regimen with a minimum of 4 drugs for at least 9 to 12 months, during which the tolerability of the drugs and their interactions should be carefully evaluated. It is difficult to diagnose and treat TB in immunocompromised children. Thus, all pediatric patients undergoing immunosuppressive therapy who develop TB should be diagnosed and treated at a TB reference center, which should also be responsible for the recommended follow-up.
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ISSN:0149-2918
1879-114X
1879-114X
DOI:10.1016/j.clinthera.2015.10.012