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Tuberkulose im Kindesalter

Stand des Wissens

Tuberculosis in childhood

State of knowledge

  • Pädiatrische Pneumologie
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die Prävention, Diagnostik und Behandlung von Tuberkuloseerkrankungen im Kindesalter stellt weiterhin eine Herausforderung dar. Aufgrund des erhöhten Risikos für schwere und disseminierte Erkrankungsformen der Tuberkulose (TB) wird bei Kindern unter 5 Jahren bei Exposition zu einer offenen TB unabhängig von den initialen immunologischen Testergebnissen immer eine prophylaktische Therapie mit Isoniazid (INH) über 3 Monate empfohlen. Bei asymptomatischer (latenter) TB sollte entweder die Gabe von INH über 9 Monate oder die Kombinationsbehandlung mit INH und Rifampicin (RMP) über 3 Monate erfolgen. Im Falle der im Kindesalter überwiegend pauzibazillären unkomplizierten aktiven TB ist meist eine 2-monatige Dreifachkombinationstherapie (RMP, INH, PZA) gefolgt von einer 4-monatigen RMP/INH-Therapie ausreichend. Insbesondere bei Kleinkindern ist die zeitnahe Diagnosestellung und effektive Therapie zur Verhinderung lebensbedrohlicher Krankheitsverläufe von entscheidender Bedeutung. Die weltweite Zunahme multiresistenter TB-Keime stellt eine therapeutische Herausforderung dar. Die Betreuung von Kindern und Jugendlichen sollte in diesem Fall durch spezialisierte Zentren erfolgen.

Abstract

The prevention, diagnosis and treatment of childhood tuberculosis (TB) remain a challenge. As a result of an increased risk of disease progression after infection in children < 5 years of age, prophylactic treatment with isoniazide (INH) for 3 months is indicated after contact with infected TB patients. For patients with (asymptomatic) latent TB, treatment with INH for 9 months or INH and rifampicine (RMP) for 3 months is indicated for all children and adolescents. Uncomplicated active TB in children can most commonly be treated with a combination of RMP, INH and pyrazinamide (PZA) during the first 2 months followed by a combination of RMP and PZA for the following 4 months. Especially in young children, rapid diagnosis and treatment is crucial because of an increased risk of disseminated life-threatening tuberculosis. The worldwide increase in drug-resistant TB is challenging and children and adolescents should be managed out in specialist centers.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Brinkmann, S. Thee und N. Ritz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    F. Brinkmann

  2. Kinderklinik, DRK Kliniken Westend, Berlin, Deutschland

    S. Thee

  3. Klinik für Pädiatrie m. S. Pädiatrische Pneumologie und Immunologie, Charité - Campus Virchow Klinikum, Berlin, Deutschland

    S. Thee

  4. Abteilung für Infektiologie und Vakzinologie, Universitäts Kinderklinik beider Basel, Universität Basel, Basel, Schweiz

    N. Ritz

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  1. F. Brinkmann
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  3. N. Ritz
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Correspondence to F. Brinkmann.

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Brinkmann, F., Thee, S. & Ritz, N. Tuberkulose im Kindesalter. Pneumologe 11, 161–170 (2014). https://doi.org/10.1007/s10405-014-0779-7

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  • DOI: https://doi.org/10.1007/s10405-014-0779-7

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