<p>A new review offers physicians tips for diagnosing, managing, and reducing the high rates of tuberculosis (TB) in certain populations in Canada.</p><p>Writing in <a href="http://www.cmaj.ca/lookup/doi/10.1503/cmaj.151212" target="_blank"><em>CMAJ</em></a>, the Canadian Medical Association Journal, the authors explained that while tuberculosis is generally uncommon among children in Canada, endemic cases continue to develop in aboriginal and foreign-born children, as well as those with foreign-born parents -- potentially creating a public health threat.</p><p><a href="http://www.sickkids.ca/AboutSickKids/Directory/People/K/Ian-Kitai-staff-profile.html" target="_blank">Ian Kitai, MD</a>, of the Hospital for Sick Children in Toronto, told <em>MedPage Today</em>: "Foreign-born children may arrive in Canada with latent -- dormant -- TB infection that activates after arrival. They, and the children of foreign-born parents, may acquire TB when an adult or adolescent in the home or extended family develops active and infectious TB."</p><p>Infection can also be acquired during visits to friends and relatives abroad, he noted.</p><p>Although the global incidence of TB is still much higher than in Canada -- 133 per 100,000 versus 4.6 per 100,000, respectively -- the latter "obscures marked regional variability," he and his colleagues explained.</p><p>"High rates of TB among the Inuit and other Aboriginal groups in Canada deserve much greater national focus and will require coordinated public health measures and innovative programs, but also substantial improvement in housing and living conditions."</p><p><strong>Symptoms </strong></p><p>While fever, night sweats, and weight loss are classic indicators of pulmonary TB in adult patients, TB in children and adolescents can be harder to diagnosis, the researchers noted.</p><p>For example, infants and young children have difficulty containing the infection to one organ system, which can often hinder diagnosis. Clinical indicators of a TB diagnosis include a history of weight loss or failure to thrive, a cough that lasts longer than 2 weeks, and prolonged fever -- all which have poor sensitivity and specificity and can easily be mistaken for something else.</p><p>Symptoms of TB in adolescents include fever, night sweats, and weight loss. Pulmonary TB is the most common form of TB at this age and is associated with markers such as cough and hemoptysis, the team wrote.</p><p>About 5-10% of patients with latent TB are at risk for acquiring active TB disease over their lifetime, but up to 50% of children younger than 1 year will acquire TB disease.</p><p><strong>Testing and Management</strong></p><p>Kitai said that because of the many ways TB can present, it should be suspected in any child with epidemiologic risk factors and suggestive symptoms or signs of organ involvement that are not explained by other diagnoses.</p><p>When it comes to identifying TB in children and teens, "clinical suspicion is critical," followed by diagnostic imaging, ancillary laboratory tests, and microbiologic confirmation.</p><p>TB skin tests and interferon gamma release assays may also aid diagnosis, although the results are not always reliable, he cautioned, pointing to a 2011 meta-analysis showing that the tests may appear negative in nearly 30% of children with TB disease.</p><p>The authors also warned of commonly missed opportunities for early diagnosis of TB, including failure to consider epidemiologic history, obtain sputum for TB culture, send biopsy specimens for TB culture, consider a diagnosis of TB, or reconsider a negative result for the tuberculin skin test.</p><p>Finally, the best way to conduct treatment is with a comprehensive team of clinicians, public health nurses, translation services, and social workers with experience in the management of pediatric TB, the researchers said.</p><p>All children and adolescents exposed to infectious TB should receive a tuberculin skin test and a chest radiograph. If the skin test result shows as negative, it should be repeated 8 to 10 weeks after the last date of contact with an infectious source case. Those with a positive tuberculin skin test result and no clinical or radiologic evidence of disease should be treated for latent TB infection based on source case sensitivities.</p><p>In the interview, Kitai said that better screening and treatment of those at risk for latent TB infection -- as well as early identification, isolation, and treatment of those with infectious TB -- may help prevent TB within Canada.</p><p>"A strong local, provincial, and federal public health infrastructure has helped reduce TB rates and must be maintained and strengthened. Assisting with efforts to control the global TB epidemic will also help reduce TB in Canada."</p><p>He also referenced the role of social determinants of health, including poverty and overcrowding: "Addressing these and maintaining and strengthening public health infrastructure are all important for TB control. Innovative programs such as <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__taimatb.tunngavik.com_&d=DQMF-g&c=Dvjge31PR3JZstzk2paJYiflTxRSxp35GBhsbHdd2Zw&r=JCZMgwKYKRKiCmStF7H6PmdlMStOcr3v4hQH2iQC6zk&m=8WKPnZyi0N_2VfLNwongi6LqsbPymeJhhA8l2RCEtSU&s=vUirjoBMoN959lJIm73RB52_lMm6cZgqPHuda-b4maw&e=" target="_blank">Taima</a> TB [a group of research projects aimed at helping Inuit people in Canada stop the transmission of TB], which stress community participation, have helped address the problem in [the Canadian territory of] Nunavut."</p><div style="float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;"><p>Kitai and the other co-authors declared no competing interests.</p></div><div style="clear:both;"></div>
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