DIAGNOSIS AND MANAGEMENT CHALLENGES OF CHILD TUBERCULOSIS IN ASIA IN THE ERA OF DRUG RESISTANT TUBERCULOSIS
Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, UniversitasGadjahMada, Yogyakarta, Indonesia
Tuberculosis (TB) ranks the first among the top 10 killer infectious diseases, overtaking HIV/AIDS. Fifty six percent of TB cases in the world were in five Asia countries (India, Indonesia, China, the Philippines and Pakistan), which thereby contribute greatly to global TB burden. In addition, India and China have major contribution to almost half of the global drug resistant TB (DR TB). With a large number of adults with TB cases, children in Asia are at high risk to get TB infection and develop the disease. The diagnosis and management of child TB pose more challenges in the era of DR TB epidemic. Diagnosis of DR TB in children requires a microbiological confirmation. Nevertheless, the difficulty in collecting sputum from young children and the paucibacillary nature of child TB may lead to negative result of sputum smear and culture. Xpert MTB/RIF and line probe assays have been significant advancement of diagnostic test for TB in children in the urgent for simple and rapid diagnostic tools. The sensitivity is better compared to sputum smear even though remained suboptimum than culture. However, this tool has not been available in most primary level of health cares in most countries in Asia. There are relatively few clinical trials on regimens for DR TB in children. The management for children with DR TB is usually extrapolated from adult guideline, which may not be appropriate. The burden of pills, the lack of child-friendly formulations and the risk of toxicity of second line anti TB drugs may hamperthe success of treatment. Finally, prevention therapy for child contacts of DR TB cases is better than cure children with DR TB. The challenge is to determine effective and safe preventive regimen for the child contacts.
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