Besonderheiten der Kindertuberkulose

Zusammenfassung

Während die Inzidenz der Tuberkulose in den meisten westlichen Industrieländern rückläufig ist, gehört diese Infektionskrankheit weltweit zu den häufigsten Todesursachen im Kindesalter. Kinder werden meist durch Erwachsene in ihrem direkten Umfeld infiziert. Die klinische Manifestation ist direkte Folge der Primärinfektion und spiegelt damit die Übertragungsrate innerhalb der Gesellschaft wider. Kinder mit unbehandelter Infektion bleiben ein lebenslanger Pool für spätere Erkrankung und Infektionsquellen. Prävention und Therapie der latenten Tuberkulose-Infektion sind daher grundlegende Aufgaben des Gesundheitssystems. Kinder haben nach Infektion mit Mycobacterium tuberculosis ein besonders hohes Erkrankungsrisiko. Die Krankheit manifestiert sich unterschiedlich und häufig schwerwiegender als bei Erwachsenen. Gleichzeitig ist die Diagnose der Tuberkulose im Kindesalter aufgrund der oft unspezifischen klinischen Präsentation sowie der Schwierigkeit des kulturellen Erregernachweises eine besondere Herausforderung. Der Artikel gibt einen Überblick über die Besonderheiten der Epidemiologie, Klinik, Diagnostik und Behandlung der Tuberkulose im Kindesalter.

Abstract

In spite of a decline in the western industrialised countries, tuberculosis remains one of the commonest causes of childhood mortality in the world. In most cases, children become infected by adults in their immediate environment. The clinical manifestation as a consequence of the primary infection reflects the community transmission of tuberculosis. Children with untreated infection remain a lifelong pool for future disease and therefore infectivity. Thus, prevention and therapy of latent tuberculosis infection are fundamental duties of the public health system. The risk of developing active disease following infection with Mycobacterium tuberculosis is especially high in children. Compared to adults, childhood tuberculosis manifests differently and is often more severe. At the same time, the diagnosis is complicated by the unspecific clinical presentation and difficulty of culture confirmation in children. This article gives an overview of the special features of the epidemiology, clinical presentation, diagnosis and management of childhood tuberculosis.

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1 Leider wird die Durchführung eines IGRA in Deutschland bisher nicht von den Krankenkassen übernommen („IGEL-Leistung”).

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