Controversies in tuberculous infection among pediatric infectious disease specialists in North America

• Published in: The international journal of tuberculosis and lung disease 2016-11, Vol.20 (11), p.1463-1468
• Main Authors: Cruz, A. T., Hersh, A. L., Starke, J. R., Beekmann, S. E., Polgreen, P. M., Banerjee, R.
• Format: Article
• Language: English
• Subjects: Child; Communicable Diseases - diagnosis; Communicable Diseases - epidemiology; Disease Management; Humans; interferon-gamma release assay (IGRA); Interferon-gamma Release Tests; Internet; Latent Tuberculosis - diagnosis; Latent Tuberculosis - epidemiology; Mycobacterium; North America - epidemiology; Pediatrics; Practice Guidelines as Topic; Practice Variation; Risk Factors; Surveys and Questionnaires; Treatment Regimens; Tuberculin Test
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.16.0366

OBJECTIVE: 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.DESIGN: We conducted an online survey of the Infectious Diseases Society of America's Emerging Infections Network (EIN) membership.RESULTS: 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.CONCLUSION: 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.