Venturini E, Tersigni C, Chiappini E, de Martino M, Galli L
a Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
Expert Rev Anti Infect Ther. 2017 Apr;15(4):341-349. doi: 10.1080/14787210.2017.1279541. Epub 2017 Jan 16.
The management of latent tuberculosis (LTBI) in children represents an important issue for paediatricians because of the disease burden, the lack of a gold standard for the diagnosis and the high annual risk of progression to active disease. Areas covered: A review of English language articles on LTBI in children, published between the 1st of January 2010 and the 1st of July 2016, was conducted using multiple keywords and standardized terminology in PubMed database. This review provides an updated overview of the available tests for LTBI diagnosis in children, management strategies and treatment options. Expert commentary: Two tests are available for LTBI diagnosis: tuberculin skin test and interferon-gamma release assays, both with a suboptimal specificity and sensitivity, and both with the lack of capability in distinguishing between infection and disease. Several new markers have been identified but further studies are needed. Among all treatment regimes, because of the high safety and efficacy profile showed and to avoid the poor completion rate, the treatment with a three-month course of isoniazid and rifampicin is currently recommended. New vaccines are needed because of the spread of the disease despite BCG vaccination in high risk countries. Currently, 15 new vaccines are in the pipeline.
由于疾病负担、缺乏诊断的金标准以及每年进展为活动性疾病的高风险，儿童潜伏性结核病（LTBI）的管理对儿科医生来说是一个重要问题。涵盖领域：使用PubMed数据库中的多个关键词和标准化术语，对2010年1月1日至2016年7月1日期间发表的关于儿童LTBI的英文文章进行了综述。本综述提供了儿童LTBI诊断的现有检测方法、管理策略和治疗选择的最新概述。专家评论：有两种检测方法可用于LTBI诊断：结核菌素皮肤试验和干扰素-γ释放试验，两者的特异性和敏感性都不理想，且都无法区分感染和疾病。已经鉴定出几种新的标志物，但还需要进一步研究。在所有治疗方案中，由于显示出高安全性和有效性，且为避免低完成率，目前推荐使用异烟肼和利福平三个月疗程的治疗方法。尽管在高风险国家接种了卡介苗，但由于疾病的传播，仍需要新的疫苗。目前，有15种新疫苗正在研发中。
