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Tuberculosis: diagnosis, management and prevention
  1. Delane V Shingadia,
  2. J Harry Baumer
  1. Derriford Hospital, Plymouth, Devon, UK
  1. For correspondence:
    Dr J H Baumer
    Derriford Hospital, Plymouth, Devon PL6 8DH, UK; harry.baumer{at}phnt.swest.nhs.uk

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Tuberculosis in children remains an important part of the expected knowledge base for any paediatrician. Despite the fact that it is on the increase, it is still seen relatively infrequently in general paediatric practice.

The National Institute for Health and Clinical Excellence (NICE) has recently produced a detailed evidence-based guideline on its prevention, recognition and management in both children and adults.1 This replaces previous guidelines produced by the Joint Tuberculosis Committee of the British Thoracic Society. The guideline is very detailed, with the full guideline running to over 200 pages including references. It does not separate the guidance for children and adults. If the guidance relevant to children is put together, the resulting recommendations, even without any of the supporting evidence, run to over 2500 words. The guideline includes some important information likely to be new to many non-specialist paediatricians, and this review attempts to highlight relevant points, as well as outline the scope of the guideline relevant to children. It is therefore particularly important that paediatricians refer to the original guideline when seeking guidance on tuberculosis.

The levels of evidence and grading of recommendations were defined in the guideline. For diagnostic studies, a grade B recommendation indicates a high level of evidence. Grade D (GPP) recommendations are good practice points based on the experience of the guideline development group (GDG).

DIAGNOSIS

Diagnosing latent tuberculosis

The tuberculin skin test is the traditional way of determining tuberculosis infection, despite low sensitivity (particularly in immunocompromised individuals) and low specificity (particularly in the presence of previous BCG vaccination and exposure to environmental mycobacteria). Two new interferon-γ immunological tests, the QuantiFERON-TB Gold and T-SPOT.TB, are commercially available in the UK. Both tests measure interferon-γ responses in the blood to two tuberculosis -specific antigens which are neither present in BCG nor in most atypical mycobacteria: early secretion antigen …

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