Management of Latent Tuberculosis Infection in Children from Developing Countries
Tuberculosis (TB), once widely prevalent throughout the world, experienced falling incidence rates in early twentieth century in developed nations, even before the introduction of anti-TB drugs, attributed to improved hygiene and living conditions. Active TB may develop following fresh infection or activation of latent tuberculosis infection (LTBI). LTBI is a state of persistent bacterial viability, however, the host stays asymptomatic and there is no evidence of clinically active tuberculosis. Therefore, treatment of all LTBI is considered as one of the ways to control tuberculosis. Diagnosis of LTBI relies on presence of immune-reactivity to TB antigen and commonly used tests include tuberculin skin test and interferon gamma release assay (IGRA). At present there is no diagnostic test that can identify an individual with LTBI who will progress to develop active disease or remain asymptomatic. Therefore, it is unclear whom to treat. In the current scenario, treatment for LTBI is restricted to high risk groups which include under-5 y contacts of adults with pulmonary TB. Various regimens for treatment of LTBI are evolving and consist of isoniazid (INH) alone for 6–9 mo or combination of INH and rifampicin for 3–4 mo or once a week combination of rifapentin and INH for 3 mo. There is a need for research to identify LTBI, risk factors for progression of LTBI to active disease and a shorter regimen for treatment.
KeywordsInterferon gamma assay INH prophylaxis IPT Rifapentin Tuberculin skin test
AJ: Performed literature search and wrote manuscript; RL: Planned the literature search and was involved in manuscript writing. RL will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 7.WHO | WHO End TB Strategy [Internet]. WHO. Available at: http://www.who.int/tb/post2015_strategy/en/. Accessed 9 Sept 2018.
- 8.Getahun H, Kittikraisak W, Heilig CM, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med [Internet]. 2011;8:18. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022524/. Accessed 9 Sept 2018.
- 10.Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10:1192–204.Google Scholar
- 11.Lockman S, Tappero JW, Kenyon TA, Rumisha D, Huebner RE, Binkin NJ. Tuberculin reactivity in a pediatric population with high BCG vaccination coverage. Int J Tuberc Lung Dis. 1999;3:23–30.Google Scholar
- 12.Dorman SE, Belknap R, Graviss EA, et al. Interferon-γ release assays and tuberculin skin testing for diagnosis of latent tuberculosis infection in healthcare workers in the United States. Am J Respir Crit Care Med. 2014;189:77–87.Google Scholar
- 13.WHO | Latent TB Infection : Updated and consolidated Guidelines for Programmatic Management [Internet]. WHO. Available at: http://www.who.int/tb/publications/2018/latent-tuberculosis-infection/en/. Accessed 9 Sept 2018.
- 14.Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010;1:CD000171.Google Scholar
- 15.Zunza M, Gray DM, Young T, Cotton M, Zar HJ. Isoniazid for preventing tuberculosis in HIV-infected children. Cochrane Database Syst Rev. 2017;8:CD006418.Google Scholar
- 18.Zeidberg LD, Dillon A, Gass RS. Risk of developing tuberculosis among children of tuberculous parents. Am Rev Tuberc Pulm Dis. 1954;70:1009–19.Google Scholar
- 23.Spyridis NP, Spyridis PG, Gelesme A, et al. The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study. Clin Infect Dis. 2007;45:715–22.CrossRefGoogle Scholar