title: Controversies in tuberculous infection among pediatric infectious disease specialists in North America.
abstract: To evaluate the extent to which advancements in the diagnosis and treatment of latent tuberculous infection (LTBI) have been integrated into practice by pediatric infectious disease (PID) specialists.
  
  
  
  We conducted an online survey of the Infectious Diseases Society of America's Emerging Infections Network (EIN) membership.
  
  
  
  Of the 323 members, 197 (61%) responded: 7% cared for ⩾5 children with TB disease and 34% for ⩾5 children with LTBI annually. We identified substantial variations in the use of interferon-gamma release assays (IGRAs) based upon age, immune status, and TB risk factors. In addition, tuberculin skin test (TST) use was three times more common in younger children. Variations existed in managing children with discordant TST and IGRA results. Less variation existed in LTBI treatment, with 86% preferring a 9-month course of isoniazid; few other, newer regimens were used routinely.
  
  
  
  Substantial variations exist in LTBI management; uptake of newer diagnostic tools and treatment regimens has been slow. Variations in practice and the lag time to integrating new data into practice may indicate the relative infrequency with which providers encounter LTBI. Our findings reflect the need for increased visibility of existing TB guidelines and resources for expert consultation for scenarios not covered by guidelines.
authors: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
authors: A T
authors: AT
authors: Cruz
authors: University of Utah, Salt Lake City, Utah, USA.
authors: A L
authors: AL
authors: Hersh
authors: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
authors: J R
authors: JR
authors: Starke
authors: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors: S E
authors: SE
authors: Beekmann
authors: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors: P M
authors: PM
authors: Polgreen
authors: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: R
authors: R
authors: Banerjee
mesh_terms: D002648:Child; D003141:Communicable Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D019468:Disease Management; D006801:Humans; D059425:Interferon-gamma Release Tests; D020407:Internet; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014374:Tuberculin Test