Among the infectious diseases, tuberculosis (TB) is the leading cause of death worldwide, accounting for an estimated 2.9 million deaths per year. 1 The vast majority of these cases occur in developing countries. The incidence of TB in the United States had been steadily declining since 1882 as a result of improved living conditions and increased efforts to control this disease. This trend ended, however, in 1985 when the number of TB cases increased in all age groups, including the pediatric population. Between 1985 and 1992, the number of TB cases in children younger than 5 years of age increased by more than 40% .2
In addition to the trend of increasing incidence of TB, we have also seen the emergence of drugresistant strains of Mycobacterium tuberculosis (MTB).
In certain areas of the country, up to one third of all cases are reportedly resistant to one or more drugs. The case-fatality rate for disease caused by multiresistant TB is estimated to be 40% to 60%.
In response to the resurgence of TB and the increasing numbers of drug-resistant MTB, new recommendations have been made by the American Academy of Pediatrics (AAP), the advisory council of the Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America regarding screening and therapy for TB. In this article, we will review pediatric TB with an emphasis on these recent changes in recommendations.