CURRENT CONCEPTS Tuberculosis in Children

Widespread implementation of the strategy of directly observed treatment short course (DOTS) during the 1990s resulted in improved global control of tuberculosis.(1) However, its effectiveness has been limited in areas where poverty and infection with the human immunodeficiency virus (HIV) or drug-resistant tuberculosis are prevalent, and the emphasis on a positive sputum smear as the diagnostic criterion actually excludes most children from care.(2) Tuberculosis remains a major but often unrecognized cause of disease and death among children in areas where the disease is endemic(3); service delivery in such areas is hampered by the absence of pragmatic strategies to guide diagnosis and management. This article provides a brief overview of basic principles, current controversies, and recent advances related to the care of children with tuberculosis, with an emphasis on intrathoracic disease.