[Children tuberculosis after familial contamination: experience in general pediatrics].
The heterogeneity of clinical presentations of children in contact with a tuberculous adult do not allow simple guidelines for treatment and exams. Indications of thoracic computed tomography (CT) in young children and the risk of a follow-up without antituberculous treatment are always discussed.


METHODS
Sixty-nine children, belonging to 50 families, living in close contact with an adult treated for tuberculosis were explored during 7 years in a General Pediatric Unit. A CT was performed in 51 patients.


RESULTS
Mantoux test was negative in 3/17 children with typical tuberculous disease on X-ray. When results of CT were compared with those of standard thoracic X-ray, a difference for the diagnosis of mediastinal adenopathies was found only in children younger than 5 years. Fifty-eight patients were given usual treatment of latent or patent tuberculosis if indicated, or a chemoprophylaxis. All of them had normal clinical and X-ray exam 2 to 4 years later. Eleven children, initially checked in an other unit, were given no treatment, but a follow-up was set up. However, after 6 to 24 months, 4/11 had a patent tuberculosis and 5/11 a latent tuberculosis, 6/9 being aged more than 3 years.


CONCLUSIONS
This study shows that risk of tuberculosis after familial contamination is high, and that the choice of absence of treatment with following re-evaluation, is sometimes questionable because families or doctors do not perform the prescribed follow-up. To perform systematically a thoracic CT, searching for mediastinal adenopathies, is useful only before the age of 5 years.
Gendrel
D
D
Services de pédiatrie générale et urgences, hôpital Saint-Vincent-de-Paul-Cochin, université Paris-V, Assistance publique-Hôpitaux de Paris, 74-82, avenue Denfert-Rochereau, 75674 Paris cedex 14, France. dominique.gendrel@svp.ap-hop-paris.fr
Nguyen
Y
Y
Lorrot
M
M
Soulier
M
M
Royer
C
C
Moulin
F
F
Marc
E
E
Raymond
J
J
Iniguez
J-L
JL
Kalifa
G
G
D002648:Child; D002675:Child, Preschool; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*