Berti Elettra, Galli Luisa, Venturini Elisabetta, de Martini Maurizio, Chiappini Elena
BMC Infect Dis. 2014;14 Suppl 1(Suppl 1):S3. doi: 10.1186/1471-2334-14-S1-S3. Epub 2014 Jan 8.
Paediatric tuberculosis (TB) represents a major public health concern worldwide. About 1 million children aged less than 15 years develop TB each year, contributing to 3-25% of the total TB caseload. The aim of this review is to evaluate national and international guidelines concerning tuberculosis in childhood and compare them in terms of diagnosis and treatment strategies.
A literature search of the Pubmed database was performed from January 2000 to August 2013, using the terms "tuberculosis" and "children". The search was limited to guidelines and consensus conferences, human species and full text availability, with no language restrictions.
Twenty-seven national and international guidelines are identified. Several discrepancies on the diagnosis workup of TB are underlined. The main points of disagreement are represented by the interpretation of tuberculin skin test (TST) result and the recommendations on the use of TST and/or interferon-gamma release assay (IGRA) for the diagnosis of TB infection. Otherwise, all guidelines are in agreement that a microbiological confirmation should always be sought. Similarly, susceptibility drug testing and genotyping should be performed whenever it is possible on the basis of resources availability. On the contrary, the use of nucleic acid amplification tests (NAATs) for the M. tuberculosis detection is still controversial. A general consensus exists, otherwise, on TB treatment and only minor discrepancies are evidenced, such as the recommendations on daily or intermittent treatment regimens.
Despite advances in TB diagnostic tools have been reached during the last decade, a lack of uniformity in their availability, indication and interpretation has relevant consequences for clinical practice. Further studies need to be performed to clarify this issue and identify a reliable and reproducible diagnostic workup. Moreover, future studies should analyze the drug metabolism and the efficacy of intermittent dosing regimes in childhood, as well as new treatment regimens in order to improve the therapy compliance.
儿童结核病是全球主要的公共卫生问题。每年约有100万15岁以下儿童患结核病，占结核病总病例数的3%-25%。本综述的目的是评估关于儿童结核病的国家和国际指南，并在诊断和治疗策略方面进行比较。
2000年1月至2013年8月期间，在Pubmed数据库中进行文献检索，检索词为“结核病”和“儿童”。检索仅限于指南和共识会议、人类物种以及全文可用性，无语言限制。
共确定了27项国家和国际指南。强调了结核病诊断检查方面的一些差异。主要分歧点在于结核菌素皮肤试验（TST）结果的解读以及关于使用TST和/或干扰素-γ释放试验（IGRA）诊断结核感染的建议。否则，所有指南均一致认为应始终寻求微生物学确诊。同样，应根据资源可用性尽可能进行药敏试验和基因分型。相反，使用核酸扩增试验（NAATs）检测结核分枝杆菌仍存在争议。不过，在结核病治疗方面存在普遍共识，仅存在一些细微差异，例如关于每日或间歇治疗方案的建议。
尽管在过去十年中结核病诊断工具取得了进展，但其可用性、适应证和解读缺乏一致性对临床实践产生了相关影响。需要进一步开展研究以阐明这一问题并确定可靠且可重复的诊断检查方法。此外，未来的研究应分析儿童期药物代谢和间歇给药方案的疗效，以及新的治疗方案，以提高治疗依从性。
