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Recommendations for the diagnosis of pediatric tuberculosis

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Abstract

Tuberculosis (TB) is still the world’s second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.

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Acknowledgments

This study was supported by a grant obtained from the Italian Ministry of Health (Bando Giovani Ricercatori 2009).

Author information

Authors and Affiliations

  1. Department of Health Sciences, Pediatric Infectious Diseases Division, Anna Meyer Children’s University Hospital, University of Florence, Florence, Italy

    E. Chiappini & D. Ciofi

  2. Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy

    A. Lo Vecchio & A. Guarino

  3. Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy

    S. Garazzino & C. Gabiano

  4. Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    G. L. Marseglia

  5. Pediatric Emergency Unit, University of Bologna, Bologna, Italy

    F. Bernardi

  6. Infectious Diseases Unit, IRCCS Giannina Gaslini, Genoa, Italy

    E. Castagnola & G. Losurdo

  7. Radiology Unit, IRCCS Bambino Gesù Hospital, Rome, Italy

    P. Tomà

  8. Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy

    D. Cirillo & E. Tortoli

  9. Virology Unit, IRCCS Bambino Gesù Hospital, Rome, Italy

    C. Russo

  10. Pneumology Unit, University of Naples Federico II, Naples, Italy

    M. Bocchino

  11. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy

    M. Tadolini

  12. Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy

    A. Villani

  13. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy

    S. Esposito

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  1. E. Chiappini
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  2. A. Lo Vecchio
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  6. E. Castagnola
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  7. P. Tomà
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  8. D. Cirillo
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  9. C. Russo
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  13. M. Bocchino
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  14. E. Tortoli
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  18. S. Esposito
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Consortia

for the Italian Pediatric TB Study Group

Corresponding author

Correspondence to S. Esposito.

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The authors declare that they have no competing interests.

Additional information

The Italian Pediatric TB Study Group also includes: Nicola Principi, Samantha Bosis, Claudia Tagliabue, Laura Senatore, Beatrice Ascolese (Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy); Laura Lancella, Laura Cursi, Annalisa Grandin, Caterina Marabotto (Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy); Luisa Galli, Maurizio de Martino, Carlotta Montagnani, Filippo Festini, Martina Anziati, Sabrina Becciani, Giulia Remaschi, Sara Sollai, Chiara Tersigni, Elisabetta Venturini (Department of Health Science, University of Florence, Anna Meyer Clidren’s University Hospital, Florence, Italy); Riccardo Scotto (Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy); Elisa Bertazzoni (Pharmacology Unit, University of Verona, Verona, Italy); Francesco Blasi (Pneumology Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy); Luca Assante (Pneumology Unit, University of Naples Federico II, Naples, Italy); Luigi Codecasa (Referral Center for Tuberculosis, Lombardy Region, Milan, Italy); Giuseppe Di Mauro (primary care pediatrician, Caserta, Italy); Marino Faccini (Prevention Department ASL Milano, Milan, Italy); Daniele Le Serre, Irene Raffaldi (Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy); Amelia Mascolo (Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy); Amelia Di Comite, Mauro Stronati (Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy); Giovanni Battista Migliori, Rosella Centis, Lia D’Ambrosio (World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy); Alberto Matteelli (World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland); Angela Pasinato (primary care pediatrician, Vicenza, Italy); Franco Scaglione (Pharmacology Section, Università degli Studi di Milano, Milan, Italy); Elisabetta Scala (MOIGE Association, Rome, Italy).

Scientific Societies involved in the Italian Pediatric TB Study Group: Società Italiana di Neonatologia (SIN), represented by Amelia Di Comite and Mauro Stronati; Società Italiana di Infettivologia Pediatrica (SITIP), represented by Susanna Esposito, Maurizio de Martino, Luisa Galli, Alfredo Guarino, Laura Lancella, Andrea Lo Vecchio, Nicola Principi, Samantha Bosis, Elio Castagnola, Clara Gabiano, Silvia Garazzino, Giuseppe Losurdo, Carlotta Montagnani, Martina Anziati, Beatrice Ascolese, Sabrina Becciani, Laura Cursi, Annalisa Grandin, Daniele Le Serre, Caterina Marabotto, Irene Raffaldi, Giulia Remaschi, Riccardo Scotto, Laura Senatore, Sara Sollai, Claudia Tagliabue, Chiara Tersigni and Elisabetta Venturini; Società Italiana di Pediatria (SIP), represented by Alberto Villani, Cristina Russo and Paolo Tomà; Società Italiana di Malattie Respiratorie Infantili (SIMRI), represented by Filippo Bernardi; Società Italiana di Immunologia e Allergologia Pediatrica (SIAIP) represented by Gianluigi Marseglia and Amelia Mascolo; Società Italiana di Pediatria Preventiva e Sociale (SIPPS), represented by Giuseppe Di Mauro and Elena Chiappini; Società Italiana per le Cure primarie Pediatriche (SiCUPP), represented by Angela Pasinato; Società Italiana di Malattie Respiratorie (SIMER), represented by Francesco Blasi, Marialuisa Bocchino and Luca Assante; Associazione Italiana Pneumologi Ospedalieri (AIPO), represented by Luigi Codecasa; Società Italiana di Malattie Infettive e Tropicali (SIMIT), represented by Alberto Matteelli; Associazione Microbiologi Clinici Italiani (AMCLI), represented by Enrico Tortoli; Società Italiana di Chemioterapia (SIC), represented by Elisa Bertazzoni; Società Italiana di Farmacologia (SIF), represented by Francesco Scaglione; STOP TB, represented by Daniela Cirillo, Marino Faccini, Giovanni Battista Migliori, Rosella Centis and Marina Tadolini; Società Italiana di Scienze Infermieristiche Pediatriche (SISIP), represented by Filippo Festini and Daniele Ciofi; MOIGE, represented by Elisabetta Scala.

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Chiappini, E., Lo Vecchio, A., Garazzino, S. et al. Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 35, 1–18 (2016). https://doi.org/10.1007/s10096-015-2507-6

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