title: [Children exposed to multidrug-resistant tuberculosis: How should we manage? Analysis of 46 child contacts and review of the literature].
abstract: BACKGROUND
  Tuberculosis-related morbidity and mortality remain important. Emergence and diffusion of multidrug-resistance tuberculosis (MDR-TB) is a global public health concern. Cases of MDR-TB in children are a sentinel event indicating the spread of a mycobacterial strain within a community. Latent TB precedes MDR-TB and screening and follow-up of contact individuals are key points of TB infection control.
  
  
  METHODS
  We performed the case-investigation of 20 adult cases of MDR-TB managed in our institution.
  
  
  RESULTS
  Forty-six pediatric contact individuals were identified. A high proportion of these children were lost to follow-up (80% at 12 months), showing that monitoring this reservoir population with migrant history is challenging. Five (11%) children presented a secondary infection: one child was diagnosed with active TB infection (positive tuberculin skin test associated with abnormalities on chest computer tomography [CT] scan). Four children were diagnosed with latent TB infection (isolated positive tuberculin skin test with normal CT scan). Two of these children received a treatment adjusted to the strain of the index case.
  
  
  CONCLUSIONS
  In the setting of emerging MDR-TB, tuberculin skin test may be likely replaced by specific interferon-gamma release assays (IGRA), independent of prior BCG vaccination. In addition, chest CT scan is preferred to chest X-ray to detect TB lesions. The management of latent TB infection is controversial: immediate treatment with second-line anti-TB drugs adapted to the index case strain or, consistently with WHO guidelines, a simple follow-up with subsequent treatment in case of active TB.
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Service de pneumologie et d'allergologie pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France. Electronic address: gaud.catho@chu-lyon.fr.
authors.forename: G
authors.initials: G
authors.lastname: Catho
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Service de pneumologie et d'oncologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France.
authors.forename: A
authors.initials: A
authors.lastname: Sénéchal
authors.affiliation: Centre de lutte antituberculeuse du Rhône (CLAT 69), 69264 Lyon, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Ronnaux-Baron
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Valour
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Perpoint
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Bouaziz
authors.affiliation: Laboratoire de microbiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France.
authors.forename: O
authors.initials: O
authors.lastname: Dumitriescu
authors.affiliation: Service de pneumologie et d'allergologie pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
authors.forename: P
authors.initials: P
authors.lastname: Reix
authors.affiliation: Service de pneumologie et d'allergologie pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
authors.forename: C
authors.initials: C
authors.lastname: Pedone
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Inserm U1111 CIRI, université Claude-Bernard - Lyon I, 69007 Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Ader
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D064704:Levofloxacin / Q000627:therapeutic use; D059012:Lost to Follow-Up; D008297:Male; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D000583:Amikacin
keywords: Antituberculeux de seconde ligne; Antituberculosis preventive treatment; Enfants contacts; Infection tuberculeuse latente; Latent tuberculosis; Multidrug-resistant tuberculosis; Pediatric contact cases; Second-line antituberculosis drugs; Traitement préventif antituberculeux; Tuberculose multi-résistante