title: Recommendations Concerning the Therapeutic Approach to Immunocompromised Children With Tuberculosis.
abstract: OBJECTIVE
  This article describes the recommendations of a group of scientific societies concerning the therapeutic approach to immunocompromised children with tuberculosis (TB).
  
  
  METHODS
  Using the Consensus Conference method, relevant publications in English were identified by a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until December 31, 2014.
  
  
  RESULTS
  On the basis of their clinical experience and the published evidence, the group of experts concluded that, although immunosuppressed subjects are at greater risk of developing TB, none of the signs or symptoms is sensitive or specific enough to enable a diagnosis. Immunocompromised patients are at greater risk of developing extrapulmonary forms of TB, especially if they are adolescents, whereas pulmonary forms are more prevalent among younger patients. When TB is suspected, a combination of skin and immunologic tests and other clinical, radiologic, and microbiologic examinations can be used to assess the risk of infection or disease. If the TB diagnosis is confirmed, immunocompromised children should be treated by using a standard regimen with a minimum of 4 drugs for at least 9 to 12 months, during which the tolerability of the drugs and their interactions should be carefully evaluated.
  
  
  CONCLUSIONS
  It is difficult to diagnose and treat TB in immunocompromised children. Thus, all pediatric patients undergoing immunosuppressive therapy who develop TB should be diagnosed and treated at a TB reference center, which should also be responsible for the recommended follow-up.
authors.affiliation: Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lancella
authors.affiliation: Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.affiliation: Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.affiliation: Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Montagnani
authors.affiliation: Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Gabiano
authors.affiliation: Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garazzino
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Tadolini
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.affiliation: World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Battista Migliori
authors.affiliation: Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.affiliation: Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: susanna.esposito@unimi.it.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000188:drug therapy; D032921:Consensus; D003697:Delphi Technique; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: HIV; TB; children; immunodeficiency; immunosuppressants; tuberculosis