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Management der latenten tuberkulösen Infektion (LTBI) bei Kindern und Jugendlichen in Deutschland, Österreich und der Schweiz
Management der latenten tuberkulösen Infektion (LTBI) bei Kindern und Jugendlichen in Deutschland, Österreich und der Schweiz
Background Taking into account WHO´s Global End TB Strategy until 2035 and the fact that more than 2 billion people in the world are infected with Mycobacterium tuberculosis, inter-nationally coordinated struggle is needed to tackle the disease. This struggle must in-clude not only active TB disease, but also the latent form of the infection (LTBI), which is far more frequent and for which there is a lack of algorithms particularly for the pediatric setting. This study aimed to find out as much as possible about epidemi-ology and workload, but mainly diagnostic, therapeutic and follow-up approaches in the field of pediatric LTBI within the three low-TB-incidence countries Switzerland, Austria and Germany. It was conducted directly before apparition of the German-speaking medical society for pediatric infectious diseases (DGPI)´s guidelines on pe-diatric tuberculosis and thus gives an insight into modus operandi without the influ-ence of recently published guidelines. Methods We created a survey consisting of 51 questions which was then made available online for four months in late 2017. Medical societies from all three countries which are ac-tive in pediatric infectiology or pediatric pneumology as well as the German and Aus-trian public health sector and the Swiss Pulmonary League were asked to work on the survey online or with the help of personal interviews. Results A total of 173 practitioners took part in the survey. 76.1% of them prefer QuantiFER-ON over T-SPOT.TB when it comes to immunological diagnostic via IGRA. 63% vary their diagnostic approach depending on their patient´s age. Chemopreventative therapy of Isoniazid (INH) in combination with Rifampicin (RMP) seems to be largely accept-ed even though it has only recently been considered as equal to INH monotherapy. Chest X-Ray after completion of the chemopreventative regimen is conducted in 49.6% of cases. Discussion Routine TB diagnostics including CT imagery was quite popular even though there are both well-established such as CXR and promising new diagnostic technologies such as sonography. Imaging should also take place after the end of preventative therapy. Un-der-dosage remains a problem with around 41% of participants administering too low amounts of anti-TB agents in both mono- and combination therapy. It should be em-phasized that follow-up needs to take place even in preventative therapy. More teach-ing events on pediatric TB and LTBI are desirable.
LTBI, Tuberkulose, Kinder
Gerlach, Philipp
2023
German
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Gerlach, Philipp (2023): Management der latenten tuberkulösen Infektion (LTBI) bei Kindern und Jugendlichen in Deutschland, Österreich und der Schweiz. Dissertation, LMU München: Faculty of Medicine
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Abstract

Background Taking into account WHO´s Global End TB Strategy until 2035 and the fact that more than 2 billion people in the world are infected with Mycobacterium tuberculosis, inter-nationally coordinated struggle is needed to tackle the disease. This struggle must in-clude not only active TB disease, but also the latent form of the infection (LTBI), which is far more frequent and for which there is a lack of algorithms particularly for the pediatric setting. This study aimed to find out as much as possible about epidemi-ology and workload, but mainly diagnostic, therapeutic and follow-up approaches in the field of pediatric LTBI within the three low-TB-incidence countries Switzerland, Austria and Germany. It was conducted directly before apparition of the German-speaking medical society for pediatric infectious diseases (DGPI)´s guidelines on pe-diatric tuberculosis and thus gives an insight into modus operandi without the influ-ence of recently published guidelines. Methods We created a survey consisting of 51 questions which was then made available online for four months in late 2017. Medical societies from all three countries which are ac-tive in pediatric infectiology or pediatric pneumology as well as the German and Aus-trian public health sector and the Swiss Pulmonary League were asked to work on the survey online or with the help of personal interviews. Results A total of 173 practitioners took part in the survey. 76.1% of them prefer QuantiFER-ON over T-SPOT.TB when it comes to immunological diagnostic via IGRA. 63% vary their diagnostic approach depending on their patient´s age. Chemopreventative therapy of Isoniazid (INH) in combination with Rifampicin (RMP) seems to be largely accept-ed even though it has only recently been considered as equal to INH monotherapy. Chest X-Ray after completion of the chemopreventative regimen is conducted in 49.6% of cases. Discussion Routine TB diagnostics including CT imagery was quite popular even though there are both well-established such as CXR and promising new diagnostic technologies such as sonography. Imaging should also take place after the end of preventative therapy. Un-der-dosage remains a problem with around 41% of participants administering too low amounts of anti-TB agents in both mono- and combination therapy. It should be em-phasized that follow-up needs to take place even in preventative therapy. More teach-ing events on pediatric TB and LTBI are desirable.