title: Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis: Systematic Review and Proposed Recommendations for Pediatric Patients Living in Developed Countries. [Corrected].
abstract: Tuberculosis (TB) is a re-emerging health problem in developed countries. This paper is part of large guidelines on the global management of TB in children, by a group of scientific societies. It describes the indications to hospitalization of children with suspected or diagnosed TB, the isolation measures, hospital discharge, and re-admission into the community. Using the Consensus Conference method, relevant publications in English were identified by means of a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Available data on indications to hospitalization were mainly indirect and largely derived from observational studies. They include: (1) host-related risk factors, the main being age <12 months, immune deficiencies, and malnutrition; (2) TB-related clinical conditions that resemble those of pneumonia but also include drug-resistance; and (3) social and logistic conditions. The latter are based on opinion and depend on local conditions. Analysis of the literature showed that patients hospitalized with suspected pulmonary TB should be put in precautionary respiratory isolation regardless of their age while they await diagnosis. The general conditions for re-admission into the community are at least 14 days of effective treatment and negative microscopic tests of 3 consecutive samples in previously microscopically positive patients. This is the first paper that provides indications to hospitalization of children with TB. Most recommendations are generally applicable in all developed countries. Some might need an adaptation to local setting, epidemiological, parameters, and availability of specific health-care facilities.
authors.affiliation: From the Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy (ALV, RS, AG); Pneumology Unit, Federico II University of Naples, Naples, Italy (MB, LRA); Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy (LL, AV); Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy (CG, SG, IR); and Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (SE).
authors.forename: Andrea Lo
authors.initials: AL
authors.lastname: Vecchio
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Bocchino
authors.forename: Laura
authors.initials: L
authors.lastname: Lancella
authors.forename: Clara
authors.initials: C
authors.lastname: Gabiano
authors.forename: Silvia
authors.initials: S
authors.lastname: Garazzino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Scotto
authors.forename: Irene
authors.initials: I
authors.lastname: Raffaldi
authors.forename: Luca Rosario
authors.initials: LR
authors.lastname: Assante
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D000367:Age Factors; D015362:Child Nutrition Disorders / Q000150:complications; D002675:Child, Preschool; D019049:Developed Countries; D024881:Drug Resistance, Bacterial; D005260:Female; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration; D008297:Male; D010356:Patient Isolation / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications / Q000628:therapy*