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Long-term Prognosis of Tuberculosis Infection and Disease in Swedish Children

Bennet, Rutger MD*; Jonsson, Jerker MD; Nejat, Sahar MD*; Olsson-Åkefeldt, Selma MD*; Eriksson, Margareta MD*

The Pediatric Infectious Disease Journal: October 2019 - Volume 38 - Issue 10 - p e243–e247
doi: 10.1097/INF.0000000000002361
Original Studies
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Background: Reports of the outcome of treatment of tuberculosis (TB) disease and infection (TBI) in children are scarce. Since 2010, we routinely use interferon-gamma release assays in addition to clinical history for the exclusion of TBI, although the safety of this approach has been questioned. We present the frequency of recurrent TB or progression to TB after treatment for TB disease or TB infection, respectively, and progression to disease in children considered TB uninfected at our pediatric TB clinic.

Methods: We included 4707 patients from 1990 to 2017. At the initial assessment, 96 (2.0%) had previously received TB treatment, 253 (5.4%) had TB disease, 1625 (35%) had TBI and 2733 (58%) children were considered uninfected. Patients were passively followed at our clinic, at the adult TB clinics in Stockholm and at the Swedish national TB registry.

Results: During a median follow-up time of 8.4 years, we found 36 cases of TB disease, with true relapses in 3/243 (1.2%) successfully treated TB patients. Preventive treatment of TBI reduced the risk of progression to TB by 85%, from 4.3% (15/349) to 0.6% (8/1262). In children considered uninfected, the risk of later developing TB was 0.07% (2/2733).

Conclusions: The effectiveness of TB management was acceptable. Our routine procedures for the exclusion of TBI appear safe.

*Astrid Lindgren Children’s Hospital

The Public Health Agency of Sweden, Stockholm, Sweden.

Accepted for publication April 5, 2019.

The authors have no funding or conflicts of interest to disclose

Address for Correspondence: Rutger Bennet, MD, Pediatric Tuberculosis Clinic, QB80, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. E-mail: rutger.bennet@sll.se.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.