[Tuberculosis: diagnosis of contact persons and chemoprophylaxis in children].
Every doctor must participate in each step of tuberculosis control including BCG vaccination and focused screening, diagnosis of contact subjects. The last is mandatory in children, due to rapid ongoing illness from primary infection (PI). The two strategies of management are the search for secondary cases around a recently diagnosed contagious tuberculosis and the search for a contaminator in front of a recent PI or illness in a child. To suppress the anonymity of notification helps. The screening relies on a "stone in the water" strategy, from close to more occasional contacts. The search for contaminators (family, collectivity) relies on chest radiography (CR) and if positive, is extended to the contaminated surroundings. The search for secondary cases relies on tuberculin intra-dermal test (IDR); if positive, a CR is asked for and always performed in aged or immunodepressed persons, and children under 5 years of age. For them, a thoracic scan is easily done because of small mediastinal adenopathies undiagnosed by plain CR. Despite imperfect sensitivity and specificity, IDR is pivotal for diagnosis in children. Any PI in children has to be treated. In France, bitherapy isoniazide-rifampicine is given before 3 years of age and often up to 10 years. A duration of 6 months is common. Patent forms receive a tri or quadri-therapy for the first 2 months followed by a 4 months bitherapy. A cornerstone of success is an adequate organisation and coordination of motivated health care workers.
Olivier
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Service de pédiatrie générale, hôpital Louis-Mourier, 178, rue Renouillers, 92700 Colombes, France. catherine.olivier@lmr.ap-hop-paris.fr
D000293:Adolescent; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration; D016358:Contact Tracing; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008403:Mass Screening; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents
Tuberculose: diagnostic des sujets contacts et chimioprophylaxie chez l'enfant.