Folke Brinkmann

S2k-Leitlinie: Tuberkulose im Erwachsenenalter

Since 2015 a significant increase in tuberculosis cases is notified in Germany, mostly due to rising numbers of migrants connected to the recent refugee crisis. Because of the low incidence in previous years, knowledge on tuberculosis is more and more limited to specialized centers. However, lung specialist and healthcare workers of other fields have contact to an increasing number of tuberculosis patients. In this situation, guidance for the management of standard therapy and especially for uncommon situations will be essential. This new guideline on tuberculosis in adults gives recommendations on diagnosis, treatment, prevention and prophylaxis. It provides a comprehensive overview over the current knowledge, adapted to the specific situation in Germany. The German Central Committee against Tuberculosis (DZK e. V.) realized this guideline on behalf of the German Respiratory Society (DGP). A specific guideline for tuberculosis in the pediatrics field will be published separately. Compared to the former recommendations of the year 2012, microbiological diagnostics and therapeutic drug management were given own sections. Chapters about the treatment of drug-resistant tuberculosis, tuberculosis in people living with HIV and pharmacological management were extended. This revised guideline aims to be a useful tool for practitioners and other health care providers to deal with the recent challenges of tuberculosis treatment in Germany.

Tuberculosis in young refugees

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Diagnostic Support for Selected Paediatric Pulmonary Diseases Using Answer-Pattern Recognition in Questionnaires Based on Combined Data Mining Applications--A Monocentric Observational Pilot Study.

Background Clinical symptoms in children with pulmonary diseases are frequently non-specific. Rare diseases such as primary ciliary dyskinesia (PCD), cystic fibrosis (CF) or protracted bacterial bronchitis (PBB) can be easily missed at the general practitioner (GP). Objective To develop and test a questionnaire-based and data mining-supported tool providing diagnostic support for selected pulmonary diseases. Methods First, interviews with parents of affected children were conducted and analysed. These parental observations during the pre-diagnostic time formed the basis for a new questionnaire addressing the parents’ view on the disease. Secondly, parents with a sick child (e.g. PCD, PBB) answered the questionnaire and a data base was set up. Finally, a computer program consisting of eight different classifiers (support vector machine (SVM), artificial neural network (ANN), fuzzy rule-based, random forest, logistic regression, linear discriminant analysis, naive Bayes and nearest neighbour) and an ensemble classifier was developed and trained to categorise any given new questionnaire and suggest a diagnosis. For estimating the diagnostic accuracy, we applied ten-fold stratified cross validation. Results All questionnaires of patients suffering from CF, asthma (AS), PCD, acute bronchitis (AB) and the healthy control group were correctly diagnosed by the fusion algorithm. For the pneumonia (PM) group 19/21 (90.5%) and for the PBB group 17/18 (94.4%) correct diagnoses could be reached. The program detected the correct diagnoses with an overall sensitivity of 98.8%. Receiver operating characteristics (ROC) analyses confirmed the accuracy of this diagnostic tool. Case studies highlighted the applicability of the tool in the daily work of a GP. Conclusion For children with symptoms of pulmonary diseases a questionnaire-based diagnostic support tool using data mining techniques exhibited good results in arriving at diagnostic suggestions. In the hands of a doctor, this tool could be of value in arousing awareness for rare pulmonary diseases such as PCD or CF.

S2k-Leitlinie zur Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter. Eine Leitlinie unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V.

Recently, epidemiological data shows an increase of childhood tuberculosis in Germany. In addition to this, drug resistant tuberculosis becomes more frequent. Therefore, diagnosis, prevention and therapy in childhood and adolescence remain a challenge. Adult guidelines do not work for children, as there are age specific differences in manifestation, risk of progression and diagnostic as well as therapeutic pathways.The German Society for Pediatric Infectious Diseases (DGPI) has initiated a consensus-based (S2k) process and completed a paediatric guideline in order to improve and standardize care for children and adolescents with tuberculosis exposure, infection or disease.Updated dosage recommendations take age dependant pharmacokinetics in the treatment of drug sensitive but also drug resistant tuberculosis in account. In addition to this, there is a detailed chapter on perinatal exposure and disease as well as extrapulmonary manifestations.

Management of child MDR-TB contacts across countries in the WHO European Region: a survey of current practice

The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

Zeitnahe Untersuchung ist von großer Wichtigkeit

Die Bestätigung einer Tuberkuloseerkrankung ist im Kindesalter erschwert. Nicht nur Diagnostik, sondern auch Prävention und Behandlung stellen weiterhin eine Herausforderung dar. Einige wichtige Besonderheiten müssen dabei beachtet werden.

Erratum zu: Tuberkulosescreening bei asylsuchenden Kindern und Jugendlichen ≺ 15 Jahren in Deutschland

Monatsschr Kinderheilkd 2016 · 164:73 DOI 10.1007/s00112-015-0024-4

Immunodiagnosis of tuberculosis infection in children under the age of five - Which testing is feasible?

Immunodiagnosis of tuberculosis infection (TB) in children under the age of five is challenging. Current German guidelines recommend tuberculin skin testing (TST), but not interferon gamma release assays (IGRAs) as first line diagnosis. In 71 TB exposed, non BCG vaccinated and asymptomatic children under the age of five TST (cut off < 5mm) and IGRA (QuantiFERON TB Gold in tube) were performed simultanously. In four children (6%) the IGRA was inconclusive. In seven (10%) of the remaining 67 children both TST and IGRA were positive. One of those children had pulmonary TB. In one child only the TST and in five children (7%) only the IGRA was positive. One of these children developed active TB during the follow up. Conflicting results were detected in six children (9%) in total. All children with negative tests were treated with isoniazide (INH) for three months, all children with at least one positive test result were treated with INH/rifampicine for three months. This study shows that there is a number of inconclusive IGRAs in children under the age of five. Therefore, IGRAs should not replace the TST in TB diagnosis in this age group. Nevertheless, they could add sensitivity to the results of the TST testing.