Pediatric tuberculosis in Italian children: Epidemiological and clinical data from the Italian register of pediatric tuberculosis

Tuberculosis (TB) is one of the leading causes of death worldwide. Over the last decades,
TB has also emerged in the pediatric population. Epidemiologic data of childhood TB are still limited
and there is an urgent need of more data on very large cohorts. A multicenter study was conducted
in 27 pediatric hospitals, pediatric wards, and public health centers in Italy using a standardized
form, covering the period of time between 1 January 2010 and 31 December 2012. Children with
active TB, latent TB, and those recently exposed to TB or recently adopted/immigrated from a high
TB incidence country were enrolled. Overall, 4234 children were included; 554 (13.1%) children had
active TB, 594 (14.0%) latent TB and 3086 (72.9%) were uninfected. Among children with active
TB, 481 (86.8%) patients had pulmonary TB. The treatment of active TB cases was known for 96.4%
(n = 534) of the cases. Overall, 210 (39.3%) out of these 534 children were treated with three and 216
(40.4%) with four first-line drugs. Second-line drugs where used in 87 (16.3%) children with active
TB. Drug-resistant strains of Mycobacterium tuberculosis were reported in 39 (7%) children. Improving
the surveillance of childhood TB is important for public health care workers and pediatricians.
A non-negligible proportion of children had drug-resistant TB and was treated with second-line
drugs, most of which are off-label in the pediatric age. Future efforts should concentrate on improving
active surveillance, diagnostic tools, and the availability of antitubercular pediatric formulations, also
in low-endemic countries.