Koinfektionen mit humanem Immundefizienzvirus und Tuberkulose im Kindesalter

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• 作者：Dr. E.R. Maritz DTM+H ; Cert ID SA ; AHMP ; W. Schimana
• 关键词：Africa south of the Sahara ; Epidemiology ; Anti ; retroviral therapy ; Developing countries ; Isoniazid
• 刊名：Monatsschrift Kinderheilkunde
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：163
• 期：11
• 页码：1130-1137
• 全文大小：571 KB
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• 作者单位：Dr. E.R. Maritz DTM+H, Cert ID SA, AHMP (1) (3)
  W. Schimana (2)
  
  1. Pädiatrische Infektiologie, Tropenmedizin, KTK Kindertagesklinik Liestal, Oristalstr. 87A, 4410, Liestal, Schweiz
  3. Children’s Infectious Diseases Clinical Research Unit (KIDCRU), Tygerberg Children’s Hospital, Stellenbosch University, Cape Town, Südafrika
  2. Referat für Gesundheit und Umwelt München, München, Deutschland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Pediatrics
  General Practice and Family Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-0474

文摘

Human immunodeficiency virus (HIV) and tuberculosis (TB) are the most common causes of death from infectious diseases worldwide. There is a lack of epidemiological data especially for children with HIV/TB co-infections, which are regularly encountered in Sub-Saharan Africa (SSA). Both are chronic diseases with similar clinical manifestations. The reasons why HIV infections are associated with a higher susceptibility for TB is not yet fully understood. Clinical algorithms and tuberculin skin tests are not specific or sensitive enough in cases of HIV co-infection. Sputum sampling has proven to be difficult, hence the detection of TB by culturing is an exception in children. Immunological tests using interferon-gamma release assays (IGRA) are also unreliable. The recommended polymerase chain reaction (PCR) test provides information about anti-TB drug resistance in addition to pathogen identification but the method is expensive and not widely available in many countries with a high prevalence of HIV and TB. At diagnosis of TB a combination treatment should be started and after clinical stabilization antiretroviral therapy (ART) should be initiated within 2–8 weeks. This poses a challenge especially for young children in SSA as treatment options are limited due to substantial drug-drug interactions. If the diagnosis of TB is overlooked at initiation of ART a severe immune reconstitution inflammatory syndrome (IRIS) might complicate the course. A search of the surrounding area for index patients (contact tracing) and preventive therapy with isoniazid are essential but often not thoroughly implemented. In addition to optimization of diagnostic and therapeutic options, the primary prevention of pediatric HIV infection by improvement of preventive measures is the key strategy for reducing TB prevalence and child mortality.