Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

소아 결핵과 약제 내성

Pediatric tuberculosis and drug resistance

  • 김예진 (성균관대학교 의과대학 소아과학교실, 감염분과)
  • Kim, Yae-Jean (Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2009.04.07
  • 심사 : 2009.04.09
  • 발행 : 2009.05.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Drug-resistant tuberculosis in children has important implications for both the patients and tuberculosis control programs. In Korea, among all new patients, the isoniazid resistance rate was 9.9% and multidrug-resistant tuberculosis rate was 2.7% in 2004 (in patients aged 10-19 yr, the multidrug-resistant tuberculosis rate reached 2.1%). Tuberculosis in pediatric patients is difficult to diagnose because many children have nonspecific clinical signs and the detection rates of acid-fast bacilli smears and cultures are low. Therefore, every effort should be made to identify adult sources and obtain information on drug susceptibility because symptomatic adult patients have a higher chance of culture positivity and drug-susceptibility patterns are the same in most adult-child pair patients. Korean children are at significant risk of drug-resistant tuberculosis. As the isoniazid resistance rate is greater than 4% among the new cases in Korea, a four-drug regimen should be considered for initial treatment of children with active tuberculosis, unless drug-susceptibility test results are available. Treatment of drug-resistant tuberculosis in children is challenging and there are only few available data. Tuberculosis control programs should be continuous with specific focus on pediatric populations because they can serve as reservoirs for future active cases. Further studies are needed regarding treatment of drug-resistant tuberculosis in children.

키워드

참고문헌

  1. Cohn ML, Davis CL. Infectivity and pathogenicity of drug- resistant strains of tubercle bacilli studied by aerogenic infection of guinea pigs. Am Rev Respir Dis 1970;102:97-100
  2. Steiner P, Rao M, Mitchell M, Steiner M. Primary drug- resistant tuberculosis in children. Correlation of drug-susceptibility patterns of matched patient and source case strains of Mycobacterium tuberculosis. Am J Dis Child 1985; 139:780-2
  3. Snider DE, Jr, Kelly GD, Cauthen GM, Thompson NJ, Kilburn JO. Infection and disease among contacts of tuberculosis cases with drug-resistant and drug-susceptible bacilli. Am Rev Respir Dis 1985;132:125-32
  4. Schaaf HS, Vermeulen HA, Gie RP, Beyers N, Donald PR. Evaluation of young children in household contact with adult multidrug-resistant pulmonary tuberculosis cases. Pediatr Infect Dis J 1999;18:494-500 https://doi.org/10.1097/00006454-199906000-00004
  5. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: World Health Organization; 2008
  6. Kent JH. The epidemiology of multidrug-resistant tuberculosis in the United States. Med Clin North Am 1993;77: 1391-409
  7. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR, Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med 1993;328:527-32 https://doi.org/10.1056/NEJM199302253280802
  8. World Health Organization. Expanded program on immunization. Geneva: World Health Organization; 1989
  9. Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 1990-2000. Bull World Health Organ 1994;72:213-20
  10. Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis 2004;8:636-47
  11. Bai GH, Park YK, Choi YW, Bai JI, Kim HJ, Chang CL, et al. Trend of anti-tuberculosis drug resistance in Korea, 1994-2004. Int J Tuberc Lung Dis 2007;11:571-6
  12. Aziz MA, Wright A, Laszlo A, de Muynck A, Portaels F, van Deun A, et al. Epidemiology of antituberculosis drug resistance (The Global Project on Anti-Tuberculosis Drug Resistance Surveillance): an updated analysis. Lancet 2006; 368:2142-54 https://doi.org/10.1016/S0140-6736(06)69863-2
  13. Zignol M, Hosseini MS, Wright A, Weezenbeek CL, Nunn P, Watt CJ, et al. Global incidence of multidrug-resistant tuberculosis. J Infect Dis 2006;194:479-85 https://doi.org/10.1086/505877
  14. Schaaf HS, Gie RP, Beyers N, Sirgel FA, de Klerk PJ, Donald PR. Primary drug-resistant tuberculosis in children. Int J Tuberc Lung Dis 2000;4:1149-55
  15. Kassa-Kelembho E, Bobossi-Serengbe G, Takeng EC, Nambea-Koisse TB, Yapou F, Talarmin A. Surveillance of drug- resistant childhood tuberculosis in Bangui, Central African Republic. Int J Tuberc Lung Dis 2004;8:574-8
  16. Schaaf HS, Marais BJ, Hesseling AC, Gie RP, Beyers N, Donald PR. Childhood drug-resistant tuberculosis in the Western Cape Province of South Africa. Acta Paediatr 2006; 95:523-8 https://doi.org/10.1080/08035250600675741
  17. Smith KC, Seaworth BJ. Drug-resistant tuberculosis: controversies and challenges in pediatrics. Expert Rev Anti Infect Ther 2005;3:995-1010 https://doi.org/10.1586/14787210.3.6.995
  18. Somoskovi A, Parsons LM, Salfinger M. The molecular basis of resistance to isoniazid, rifampin, and pyrazinamide in Mycobacterium tuberculosis. Respir Res 2001;2:164-8 https://doi.org/10.1186/rr54
  19. Riska PF, Jacobs WR, Jr, Alland D. Molecular determinants of drug resistance in tuberculosis. Int J Tuberc Lung Dis 2000;4:S4-10
  20. ER4Iseman MD. Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993;329:784-91 https://doi.org/10.1056/NEJM199309093291108
  21. Sandgren A, Strong M, Muthukrishnan P, Weiner BK, Church GM, Murray MB. Tuberculosis drug resistance mutation database. PLoS Med 2009;6:e2 https://doi.org/10.1371/journal.pmed.1000002
  22. Kim HR, Hwang SS, Kim HJ, Lee SM, Yoo CG, Kim YW, et al. Impact of extensive drug resistance on treatment outcomes in non-HIV-infected patients with multidrug-resistant tuberculosis. Clin Infect Dis 2007;45:1290-5 https://doi.org/10.1086/522537
  23. Kim DH, Kim HJ, Park SK, Kong SJ, Kim YS, Kim TH, et al. Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis. Am J Respir Crit Care Med 2008;178:1075-82 https://doi.org/10.1164/rccm.200801-132OC
  24. Migliori GB, Ortmann J, Girardi E, Besozzi G, Lange C, Cirillo DM, et al. Extensively drug-resistant tuberculosis, Italy and Germany. Emerg Infect Dis 2007;13:780-2
  25. Eamranond P, Jaramillo E. Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis 2001;5:594-603
  26. Leonard MK, Osterholt D, Kourbatova EV, Del Rio C, Wang W, Blumberg HM. How many sputum specimens are necessary to diagnose pulmonary tuberculosis? Am J Infect Control 2005;33:58-61 https://doi.org/10.1016/j.ajic.2004.08.003
  27. Schaaf HS, van Rie A, Gie RP, Beyers N, Victor TC, van Helden PD, et al. Transmission of multidrug-resistant tuberculosis. Pediatr Infect Dis J 2000;19:695-9 https://doi.org/10.1097/00006454-200008000-00005
  28. Padayatchi N, Bamber S, Dawood H, Bobat R. Multidrug- resistant tuberculous meningitis in children in Durban, South Africa. Pediatr Infect Dis J 2006;25:147-50 https://doi.org/10.1097/01.inf.0000199314.88063.4c
  29. Word Health Organization. Guidelines for the management of drug-resistant tuberculosis. Geneva: World Health Organization; 2006
  30. Sneag DB, Schaaf HS, Cotton MF, Zar HJ. Failure of chemoprophylaxis with standard antituberculosis agents in child contacts of multidrug-resistant tuberculosis cases. Pediatr Infect Dis J 2007;26:1142-6 https://doi.org/10.1097/INF.0b013e31814523e4
  31. Feja K, McNelley E, Tran CS, Burzynski J, Saiman L. Management of pediatric multidrug-resistant tuberculosis and latent tuberculosis infections in New York City from 1995 to 2003. Pediatr Infect Dis J 2008;27:907-12 https://doi.org/10.1097/INF.0b013e3181783aca
  32. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161: S221-47 https://doi.org/10.1164/ajrccm.161.supplement_3.ats600
  33. Bass JB, Jr, Farer LS, Hopewell PC, OBrien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and the Centers for Disease Control and Prevention. Am J Respir Crit Care Med 1994;149:1359-74 https://doi.org/10.1164/ajrccm.149.5.8173779
  34. Mukherjee JS, Rich ML, Socci AR, Joseph JK, Viru FA, Shin SS, et al. Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet 2004;363:474-81 https://doi.org/10.1016/S0140-6736(04)15496-2
  35. Cruz AT, Starke JR. Treatment of tuberculosis in children. Expert Rev Anti Infect Ther 2008;6:939-57 https://doi.org/10.1586/14787210.6.6.939
  36. Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugsworldwide, 2000-2004. MMWR Morb Mortal Wkly Rep 2006;55:301-5