Management der latenten tuberkulösen Infektion (LTBI) bei Kindern und Jugendlichen in Deutschland, Österreich und der Schweiz

Gerlach, Philipp (2023): Management der latenten tuberkulösen Infektion (LTBI) bei Kindern und Jugendlichen in Deutschland, Österreich und der Schweiz. Dissertation, LMU München: Medizinische Fakultät

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.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: LTBI, Tuberkulose, Kinder
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 12. Januar 2023
• 1. Bericht­erstatter:in: von Both, Ulrich