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De diagnostiek en behandeling van latente tuberculose-infectie in kinderen

  • Tuberculose in Nederland
  • Published:
Tijdschrift voor Kindergeneeskunde

Summary

More often than active tuberculosis disease children have latent tuberculosis infection (ltbi), which can occur after contact with a patient suffering from smear-positive pulmonary tuberculosis, usually an adult household member. In young children the infection is almost always recently acquired. Compared to adults, infected children, especially children with an immune disorder, have an increased risk of progression to active tuberculosis disease, and will more frequently develop severe manifestations of tuberculosis, such as tuberculous meningitis or miliary tuberculosis. Treatment of ltbi considerably reduces the risk of progression to active disease. Most infected children are identified during contact investigations or immigration screening and treated by the Department of Tuberculosis Control of the Municipal Health Service. The tuberculin skin test is not always a reliable method to diagnose ltbi, particularly in children with a previous bcg vaccination or in children with a reduced immune response. Recently developed interferon-? tests may contribute to improved diagnosis of ltbi in the future. On account of the publication of new guidelines for diagnosis and treatment of ltbi in children in the United States as well as in the Netherlands, the policies and developments in the Netherlands are discussed.

Samenvatting

Vaker dan de actieve ziekte tuberculose krijgen kinderen een latente tuberculose-infectie (ltbi), die optreedt na contact met een patiënt met open tuberculose, gewoonlijk een volwassen familielid. Bij jonge kinderen is de infectie vrijwel altijd recent. In vergelijking met volwassenen hebben geïnfecteerde kinderen, zeker die met een immuunstoornis, een verhoogd risico op het ontwikkelen van de ziekte tuberculose, en worden vaker ernstige vormen van tuberculose gezien zoals meningitis tuberculosa of miliaire tuberculose. Behandeling van ltbi reduceert de kans op progressie naar de actieve ziekte sterk. Meestal worden geïnfecteerde kinderen gevonden tijdens een contactonderzoek of bij een immigratiescreening en behandeld door de afdeling Tuberculosebestrijding van de ggd. De mantouxtest is niet altijd betrouwbaar om een ltbi vast te stellen, zeker niet bij kinderen die met bcg zijn gevaccineerd of bij kinderen met een verzwakte cellulaire afweer. Onlangs ontwikkelde interferon-?-tests kunnen in de toekomst helpen de diagnostiek van ltbi te verbeteren. Naar aanleiding van het verschijnen van de nieuwe Amerikaanse richtlijnen voor de diagnostiek en behandeling van ltbi bij kinderen en de nieuwe Nederlandse richtlijn behandeling ltbi worden beleid en ontwikkelingen in Nederland besproken.

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Authors and Affiliations

  1. http://www.kindergeneeskunde.bsl.nll

    N A. H. van Hest, R. van Altena, S. M. Arend, H. W. M. Baars, J. H. van Loenhout-Rooyackers & N. G. Hartwig

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  1. N A. H. van Hest
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  2. R. van Altena
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  3. S. M. Arend
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  4. H. W. M. Baars
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  5. J. H. van Loenhout-Rooyackers
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  6. N. G. Hartwig
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Additional information

Rob van Hest, tuberculosearts/epidemioloog; Hennie Baars, tuberculosearts/epidemioloog, afdeling Tuberculosebestrijding, ggd Rotterdam e.o. Richard van Altena, longarts/landelijk consulent klinische tuberculose, Tuberculosecentrum Beatrixoord, umcg, Haren. Dr. Sandra M. Arend, interniste-infectiologe, afdeling Infectieziekten, lumc, Leiden. Dr. Joke van Loenhout-Rooyackers, longarts/tuberculosearts, afdeling Tuberculosebestrijding, ggd Regio Nijmegen. Dr. Nico Hartwig, kinderarts-infectioloog, Erasmus mc-Sophia Kinderziekenhuis, Rotterdam.

Correspondentieadres: Richard van Altena, Tuberculosecentrum Beatrixoord, Postbus 30002, 9750 RA Haren, tel: 050-5338911, fax: 050-5338650

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van Hest, N.A.H., van Altena, R., Arend, S.M. et al. De diagnostiek en behandeling van latente tuberculose-infectie in kinderen. KIND 74, 30–36 (2006). https://doi.org/10.1007/BF03061601

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