Jurcev-Savicević Anamarija, Mulić Rosanda, Klismanić Zorana, Katalinić-Janković Vera
Nastavni zavod za javno zdravstvo Splitsko-dalmatinske zupanije, Split, Hrvatska.
Acta Med Croatica. 2011 Mar;65(1):3-10.
Childhood tuberculosis (TB) has distinct epidemiological and clinical features. TB burden in children worldwide and in Croatia, the risk of infection and disease, as well as disease characteristics, sources of infection in children, diagnostic difficulties, impact of HIV on pediatric tuberculosis, limits of BCG-vaccine and program implications are discussed in this paper. Children younger than 15 years account for 15%-20% of global TB burden, which is often associated with severe TB-related morbidity and mortality. Childhood TB is rarely sputum-smear positive on microscopy. That is probably the reason for the lower priority traditionally given to children by TB control programs compared to that of adult disease. Young children are at a high risk of rapid progression from infection to disease, reflecting recent transmission rather than secondary reactivation. Therefore, the pediatric burden potentially provides a useful measure of current transmission within a community and it is a good indicator of the efficacy of TB control achieved in a particular community. Strict contact tracing and use of preventive chemotherapy is important to reduce TB-related suffering of children. Untreated latent TB infection in children provides the seed of the epidemic for the next generation. Evidence of an adult TB index case is a clue for diagnosis of childhood TB in low-endemic countries. Prognosis of early detected and properly treated TB is excellent. Consequently, new diagnostic methods and treatment options are an imperative. Among HIV-coinfected children, the optimal timing for highly active antiretroviral therapy initiation and drug combinations that have minimal interactions with anti-TB drugs need to be further explored. The most effective vaccine, suitable even for HIV-infected children, remains the need for successful prevention at the global level. The Stop TB Strategy, which builds on the previous Directly Observed Treatment Short-Course Strategy (DOTS) developed by the World Health Organization, has a critical role in reducing the worldwide burden of the disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. In addition to reducing the burden of adult TB, attention to childhood nutrition and improvement of socioeconomic conditions of communities is likely to have an impact on TB transmission to children.
儿童结核病具有独特的流行病学和临床特征。本文讨论了全球及克罗地亚儿童结核病的负担、感染和发病风险、疾病特征、儿童感染源、诊断困难、艾滋病毒对儿童结核病的影响、卡介苗的局限性以及项目意义。15岁以下儿童占全球结核病负担的15%-20%，这通常与严重的结核病相关发病率和死亡率有关。儿童结核病在显微镜下痰涂片很少呈阳性。这可能是传统上结核病控制项目对儿童的重视程度低于成人疾病的原因。幼儿从感染迅速发展为疾病的风险很高，这反映了近期的传播而非继发性再激活。因此，儿童结核病负担有可能为衡量社区内当前传播情况提供有用指标，也是特定社区结核病控制成效的良好指标。严格的接触者追踪和预防性化疗的使用对于减轻儿童结核病相关痛苦很重要。儿童未经治疗的潜伏性结核感染为下一代疫情埋下了种子。在低流行国家，成人结核病索引病例的证据是诊断儿童结核病的线索。早期发现并得到妥善治疗的结核病预后良好。因此，新的诊断方法和治疗选择势在必行。在合并感染艾滋病毒的儿童中，启动高效抗逆转录病毒治疗的最佳时机以及与抗结核药物相互作用最小的药物组合需要进一步探索。即使对感染艾滋病毒的儿童也适用的最有效疫苗，仍是全球成功预防的必要条件。在世界卫生组织先前制定的直接观察短程治疗策略（DOTS）基础上制定的《终止结核病战略》，在减轻全球疾病负担从而保护儿童免受感染和疾病方面发挥着关键作用。儿童结核病的管理应符合《终止结核病战略》，同时考虑到儿童结核病的特殊流行病学和临床表现。除了减轻成人结核病负担外，关注儿童营养和改善社区社会经济状况可能会对结核病向儿童的传播产生影响。
