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Tuberkulose im Kindesalter

Pathogenese, Prävention, Klinik und Therapie

Tuberculosis in childhood

Pathogenesis, prevention, clinical situation and therapy

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Zusammenfassung

Wenngleich die Tuberkulose im Kindesalter in Deutschland inzwischen eine seltene Infektionskrankheit geworden ist, werden die Kinderärzte auch in Zukunft, aufgrund von Bevölkerungsmigrationen aus Hochprävalenzländern, mit diesem Krankheitsbild konfrontiert sein. Gezielte Präventionsmaßnahmen sollen dazu beitragen, ein Wiederaufleben der TB in Deutschland zu vermeiden. Eine wichtige ärztliche Aufgabe besteht v. a. darin, die Tuberkulose weiterhin in die Differenzialdiagnostik einzubeziehen. So gilt es besonders, latente Infektionen mittels Infektionsanamnese, Tuberkulinhauttestung und ggf. neuen In-vitro-Testverfahren zu detektieren und bei Indikation zu behandeln. Manifeste Tuberkulosen müssen dem Standard entsprechend kombiniert therapiert werden. Eine Differenzierung von Umweltmykobakteriosen („nontuberculous mycobacteria“: NTM) und Tuberkulose, z. B. bei der zervikalen Lymphadenopathie, ist notwendig, da sich das therapeutische Vorgehen bei beiden Krankheiten wesentlich unterscheidet. Umweltmykobakteriosen scheinen bei Kindern hierzulande insgesamt zuzunehmen.

Abstract

In Germany, the incidence of childhood tuberculosis (Tb) continues to decline. Nevertheless, pediatricians are still be confronted with Tb due to migration from high incidence countries. Measures are needed to prevent the revival of Tb in Germany. This mainly involves the detection and treatment of latent Tb-infection by infection history, tuberculin-skin testing and, if necessary, interferon-gamma assays. The inclusion of Tb in the differential diagnosis of unclear lung disease is therefore important. Active disease has to be treated by combined chemotherapy as recommended. On the other hand, there seems to be an increase in infections with non-tuberculous mycobacteria (NTM). The therapy in NTM-infection differs from that in Tb, therefore differentiation between Tb and NTM-infections, for example in cervical lymphadenopathy, is important.

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Authors and Affiliations

  1. Department Lungenklinik Heckeshorn, Helios-Klinikum Emil von Behring, Berlin

    K. Magdorf

  2. Klinik für Pädiatrie m. S. Pneumologie und Immunologie, Universitätsmedizin Charité, Campus Virchow-Klinikum, Berlin

    K. Magdorf

  3. Klinik für Pädiatrie m. S. Pneumologie und Immunologie, Universitätsmedizin Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin

    K. Magdorf

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Magdorf, K. Tuberkulose im Kindesalter. Monatsschr Kinderheilkd 154, 124–132 (2006). https://doi.org/10.1007/s00112-005-1282-3

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