Children tuberculosis after familial contamination: experience in general pediatrics] |
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Authors: | D Gendrel Y Nguyen M Lorrot M Soulier C Royer F Moulin E Marc J Raymond J-L Iniguez G Kalifa |
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Institution: | 1. Department of Gynecology, Obstetrics and Reproductive Medicine, AP-HM La Conception, Pôle femmes parents enfants, 147 bd Baille, 13005 Marseille, France;2. Institut Méditerranéen de Biodiversité et d''Ecologie marine et continentale (IMBE), Aix Marseille Univ, CNRS, IRD, Univ Avignon, Marseille, France;3. Centre d''Immunophénomique - CIPHE, PHENOMIN, INSERM US012, CNRS UMS3367, UM2 Aix-Marseille Université Marseille, France;4. CNRS, Aix Marseille Univ, IRD, CEREGE UM34, UMR 7330, 13545 Aix en Provence, France;5. Laboratoire de mutagagénèse environnementale, Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, Marseille, France;6. CECOS, Laboratory of Reproductive Biology, Department of Gynecology, Obstetric and Reproductive Medicine, Pôle femmes parents enfants, AP-HM La Conception, 147 bd Baille, 13005 Marseille, France |
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Abstract: | The heterogeneity of clinical presentations of children in contact with a tuberculous adult do not allow simple guidelines for treatment and exams. Indications of thoracic computed tomography (CT) in young children and the risk of a follow-up without antituberculous treatment are always discussed. PATIENTS: Sixty-nine children, belonging to 50 families, living in close contact with an adult treated for tuberculosis were explored during 7 years in a General Pediatric Unit. A CT was performed in 51 patients. RESULTS: Mantoux test was negative in 3/17 children with typical tuberculous disease on X-ray. When results of CT were compared with those of standard thoracic X-ray, a difference for the diagnosis of mediastinal adenopathies was found only in children younger than 5 years. Fifty-eight patients were given usual treatment of latent or patent tuberculosis if indicated, or a chemoprophylaxis. All of them had normal clinical and X-ray exam 2 to 4 years later. Eleven children, initially checked in an other unit, were given no treatment, but a follow-up was set up. However, after 6 to 24 months, 4/11 had a patent tuberculosis and 5/11 a latent tuberculosis, 6/9 being aged more than 3 years. CONCLUSION: This study shows that risk of tuberculosis after familial contamination is high, and that the choice of absence of treatment with following re-evaluation, is sometimes questionable because families or doctors do not perform the prescribed follow-up. To perform systematically a thoracic CT, searching for mediastinal adenopathies, is useful only before the age of 5 years. |
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