Detection and preventive treatment of latent tuberculosis infection in children

doi:10.3969/j.issn.1000-6621.2018.05.003

Abstract

Abstract:

Latent tuberculosis infection (LTIB) seriously endangers children’s health. In children, LTBI is mostly transmitted from adult, which reflects the spread of Mycobacterium tuberculosis, disease control and epidemic situation of adult tuberculosis (TB). Therefore, strengthening the management of LTBI in children is of great significance to the prevention and control of global TB. However, there is still a lack of uniform standards and consensus for the selection of the screening indications and methods for children LTBI and the selection of preventive treatment options. The author summarizes the WHO guidelines, guidelines and recommendations of different countries and relevant clinical studies to help clinical doctors understand children LTBI high-risk groups and the screening process, and recommends relevant preventive intervention plan, so as to promote the management and diagnosis of children LTBI.

Key words: Child, Latent tuberculosis, Universal precautions, Protective agents, Intervention studies

Xue QI,Jian-ling TIAN,Lin SUN,A-dong SHEN. Detection and preventive treatment of latent tuberculosis infection in children[J]. Chinese Journal of Antituberculosis, 2018, 40(5): 447-454. doi: 10.3969/j.issn.1000-6621.2018.05.003

Figures/Tables 6

References 45

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初次感染年龄 (岁)	发展为该疾病的风险(%)
初次感染年龄 (岁)	肺结核	血行播散性结核病或结核性脑膜炎
<1	30~40	10~20
1~	10~20	2~5
2~	5	0.5
5~	2	<0.5
≥10	10~20	<0.5

机构或治疗方案	硬结平均直径≥5mm	硬结平均直径≥10mm	硬结平均直径≥15mm
WHO^[15]	严重营养不良或HIV阳性	其余儿童,无论BCG接种与否	-
美国儿科学会^[16]	HIV感染、免疫功能低下或抑制、有临床或影像学异常的疑似结核病患儿、有活动性结核病患者接触史	<4岁、慢性疾病史、移民或收养于结核病高风险国家	其余患儿
英国国家卫生与临床优化研究所^[17]	无论BCG接种与否	-	-
《儿童肺结核的临床诊断标准和治疗方案(试行)》(中国)^[18]	原发或继发免疫功能低下、营养不良、重症结核病	其他儿童,除外BCG接种免疫反应	-

推荐方法	国家或组织
单用TST	法国、巴西、瑞士、斯洛伐克(未接种BCG)、韩国(<5岁)、加拿大(<5岁接触风险低)、日本(<5岁)、爱尔兰(<5岁)、美国儿科学会(<2岁)、欧洲疾病预防控制中心
单用IGRA	挪威
两者结合
TST或IGRA二选一	丹麦、芬兰、韩国(>5岁,更倾向于TST)、美国疾病预防控制中心(<5岁者更倾向于TST)、美国儿科学会(≥5岁)
TST和IGRA同时用	加拿大(接触风险高)、捷克、克罗地亚、澳大利亚(>2岁考虑IGRA)、葡萄牙(<5岁)
先行TST,再行IGRA	德国、意大利、西班牙、沙特阿拉伯、保加利亚、荷兰(根据BCG和TST情况)、葡萄牙(>5岁)、英国(TST阴性)、加拿大(≥5岁低接触风险)、日本(≥5岁)、爱尔兰(≥5岁)

方案推荐机构	治疗方案	间隔时间	剂量(mg·kg^-1·d^-1)	最大剂量(mg/d)
WHO^[22]	6 INH或9 INH	1次/d	10	300
	3~4 RFP	1次/d	15	600
	3~4 INH+RFP	1次/d	INH:10;RFP:15	INH:300;RFP:600
	3 INH+Rft	1次/周,DOTs	INH:15(≥12岁);25(2~11岁)	INH:900;Rft:900
			Rft(根据体质量给药)^a: 10~14kg=300mg 14.1~25kg=450mg 25.1~32kg=600mg 32.1~49.9kg=750mg ≥50kg=900mg
美国儿童结核病	9 INH	1次/d	10~15	300
协作组^[26]			根据体质量给药^a: 3~5kg=50mg 6~7.5kg=75mg 7.5~10kg=100mg 10~15kg=150mg 15~20kg=200mg >20kg=300mg
		2~3次/周,DOTs	20~30	900
	6 RFP	1次/d	10~20	600
	RFP+PZA^b	-	-	-
美国胸科协会^[27]	9 INH	1次/d	10~20	300
		2次/周,DOTs	20~40	900
	4 RFP(仅INH不耐受)	1次/d	10~20	600
	3 INH+Rft^c	1次/周,DOTs	-	-
英国国家卫生与临	6 INH(吡哆醇联用)	-	-	-
床优化研究所^[17]	3 INH(吡哆醇联用)+RFP	-	-	-
欧洲疾病预防控制	HIV:6 INH或9 INH或其他方案	-	-	-
中心^[28]	非HIV:无特定方案	-	-	-