Pulmonary tuberculosis: Management in children has special considerations

doi:10.1136/bmj.332.7554.1392-b

BMJ 2006;332:1392-1393 (10 June), doi:10.1136/bmj.332.7554.1392-b

Letter

Pulmonary tuberculosis

Management in children has special considerations

The first 150 words of the full text of this article appear below.

EDITOR—The review of tuberculosis management by Campbelland Bah-Sow understates the importance of tuberculosis in children.¹An estimated 1.3 million new cases occur annually in childrenaged 15 or younger,² and one third of the 1.7 million annualdeaths occur in children.³ The distinction between latent tuberculosisinfection and tuberculosis disease is of particular importancein children. Younger infants have a greatly increased risk ofprogression from latent infection to disease, possibly as highas 40% (compared with a 10% life-time risk in adults), witha much higher incidence of extrapulmonary tuberculosis, includingtuberculous meningitis.⁴

Most paediatric tuberculosis in developed countries The diagnosisand prompt treatment of latent infection, particularly in immigrantand refugee children, is therefore of considerable importance.Admittedly, the diagnosis of tuberculosis disease in childrenis difficult, with at least half of children with the diseasebeing asymptomatic at presentation.⁵ Immunological investigations(Mantoux testing and . . . [Full text of this article]

David Burgner, senior lecturer, paediatric infectious diseases

School of Paediatrics and Child Health, University of Western Australia, Perth, WA 6009, Australia dburgner@paed.uwa.edu.au

Sarah Cherian, research fellow in refugee child health

School of Paediatrics and Child Health, University of Western Australia, Perth, WA 6009, Australia

Janet Geddes, clinical fellow in refugee child health and paediatric infectious diseases

Princess Margaret Hospital for Children, Perth, WA 6008

Delane Shingadia, consultant in paediatric infectious diseases

Great Ormond Street Hospital, London WC1