Do not routinely test children for tuberculosis (TB) exposure
Do not routinely test children for tuberculosis (TB) exposure: Excerpt from Avoiding Common Pediatric Errors
Author:
Yolanda Lewis-Ragland, MD
What to Do - Gather Appropriate Data
Mycobacterium tuberculosis (MTB) is an infectious agent that usually attacks
the lungs, but can attack almost any part of the body. It is spread from person
to person through the air by droplets when a person with MTB in their
lungs or throat coughs, laughs, sneezes, or even talks. However, significant
and repeated contact is usually required for infection. The routine universal testing of all children is no longer recommended because the conditions
under which most infections are spread, including poverty and overcrowding, are well described. After a known exposure, high-risk or symptomatic
patients are encouraged to undergo screening.
Testing
The tuberculin skin test is one method to determine if a person has TB.
Althoughthereareseveralskintestsavailable,thepreferredmethodisknown
as the Mantoux test, which involves intradermal administration of 0.1 mL
of 5 tuberculin units (TU) as a partial protein derivative (PPD), usually at
the flexor surface (dorsal or volar) of the forearm. The test should be read 48
to 72 hours after administration, and the transverse diameter of induration
should be measured in millimeters.
PPD Interpretation
The interpretation of the PPD result is determined by the risk factor(s)
of the tested individual. Three levels, based on the size of the induration,
have been recommended for defining a positive tuberculin reaction. Patients
at highest risk for developing TB (usually immunocompromised), have a
recommended threshold level of >=5 mm, whereas those individuals with
low to no risk factors have a threshold level of >15 mm. A reaction of
>=10mm should be considered positive for those with an increased probability
of recent infection or conditions that increase the risk for TB (i.e., recent
immigrants from high-prevalence countries).
Diagnosis
There is a difference between infection with MTB and having active disease.
Infected patients have the bacterium in their body. The body's defenses are
protecting them from being symptomatic with the bacteria and the individuals do not appear sick. This is referred to as latent TB infection (LTBI). Alternatively, patients with active disease experience symptoms such as cough,
fever, chills, and weight loss. These patients can spread the disease to others and require treatment as soon as possible. Once a person experiences a
positive PPD (depending on their risk factors), the next step is to determine
whether they have TB disease. This is done by obtaining a chest x-ray and
testing the patient's sputum for Mycobacterium.
Treatment
Isoniazid is the most-widely used of the antituberculosis agents—it is bactericidal, relatively nontoxic, easily administered, and inexpensive. It is often
given in combination with other drugs like rifampin (which has some important side effects, including hepatitis and thrombocytopenia), and pyrazinamide (which also adversely affects the liver). Multidrug resistance can
become a problem in treating TB, especially if a proper regimen is not implemented and adhered to. For these reasons, directly observed therapy and
the simultaneous use of multiple agents has become common.
Suggested Readings
AmericanLungAssociation.Tuberculosis(TB).Availableat:www.lungusa.org/site/pp.asp?c=
dvLUK9O0E&b=35778. Accessed November 14, 2007.
Centers for Disease Control and Prevention. http://www.cdc.gov/tb/surv/default.htm.
World Health Organization. Tuberculosis. Available at: www.who.int/mediacentre/factsheets/
fs104/en/. Accessed November 14, 2007.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
More About Tuberculosis
More Medical Textbooks Online about Tuberculosis
Review other book chapters online related to Tuberculosis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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