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Neudecker D, Fritschi N, Sutter T, Lu LL, Lu P, Tebruegge M, Santiago-Garcia B, Ritz N. Evaluation of serological assays for the diagnosis of childhood tuberculosis disease: a study protocol. BMC Infect Dis 2024; 24:481. [PMID: 38730343 PMCID: PMC11084122 DOI: 10.1186/s12879-024-09359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) poses a major public health challenge, particularly in children. A substantial proportion of children with TB disease remain undetected and unconfirmed. Therefore, there is an urgent need for a highly sensitive point-of-care test. This study aims to assess the performance of serological assays based on various antigen targets and antibody properties in distinguishing children (0-18 years) with TB disease (1) from healthy TB-exposed children, (2) children with non-TB lower respiratory tract infections, and (3) from children with TB infection. METHODS The study will use biobanked plasma samples collected from three prospective multicentric diagnostic observational studies: the Childhood TB in Switzerland (CITRUS) study, the Pediatric TB Research Network in Spain (pTBred), and the Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infections in children and adolescents (ProPAED) study. Included are children diagnosed with TB disease or infection, healthy TB-exposed children, and sick children with non-TB lower respiratory tract infection. Serological multiplex assays will be performed to identify M. tuberculosis antigen-specific antibody features, including isotypes, subclasses, Fc receptor (FcR) binding, and IgG glycosylation. DISCUSSION The findings from this study will help to design serological assays for diagnosing TB disease in children. Importantly, those assays could easily be developed as low-cost point-of-care tests, thereby offering a potential solution for resource-constrained settings. CLINICALTRIALS GOV IDENTIFIER NCT03044509.
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Affiliation(s)
- Daniela Neudecker
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland
- University of Basel Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Sutter
- Department of Computer Science, Medical Data Science, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Lenette L Lu
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Pei Lu
- Division of Geographic Medicine and Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marc Tebruegge
- Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Australia
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Paediatrics & National Reference Centre for Paediatric TB, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Begoña Santiago-Garcia
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
- Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children's Hospital Basel, University of Basel, Spitalstrasse 33, Basel, CH-4031, Switzerland.
- Department of Paediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Parkville, Australia.
- Paediatric Infectious Diseases Unit, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland.
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Rajendran P, Thomas SV, Balaji S, Selladurai E, Jayachandran G, Malayappan A, Bhaskar A, Palanisamy S, Ramamoorthy T, Hasini S, Hissar S. Paediatric pulmonary disease-are we diagnosing it right? Front Pediatr 2024; 12:1370687. [PMID: 38659699 PMCID: PMC11039875 DOI: 10.3389/fped.2024.1370687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
Background It has been reported that differential diagnosis of bacterial or viral pneumonia and tuberculosis (TB) in infants and young children is complex. This could be due to the difficulty in microbiological confirmation in this age group. In this study, we aimed to assess the utility of a real-time multiplex PCR for diagnosis of respiratory pathogens in children with pulmonary TB. Methods A total of 185 respiratory samples [bronchoalveolar lavage (15), gastric aspirates (98), induced sputum (21), and sputum (51)] from children aged 3-12 years, attending tertiary care hospitals, Chennai, India, were included in the study. The samples were processed by N acetyl L cysteine (NALC) NAOH treatment and subjected to microbiological investigations for Mycobacterium tuberculosis (MTB) diagnosis that involved smear microscopy, Xpert® MTB/RIF testing, and liquid culture. In addition, DNA extraction from the processed sputum was carried out and was subjected to a multiplex real-time PCR comprising a panel of bacterial and fungal pathogens. Results Out of the 185 samples tested, a total of 20 samples were positive for MTB by either one or more identification methods (smear, culture, and GeneXpert). Out of these 20 MTB-positive samples, 15 were positive for one or more bacterial or fungal pathogens, with different cycle threshold values. Among patients with negative MTB test results (n = 165), 145 (87%) tested positive for one or more than one bacterial or fungal pathogens. Conclusion The results suggest that tuberculosis could coexist with other respiratory pathogens causing pneumonia. However, a large-scale prospective study from different geographical settings that uses such simultaneous detection methods for diagnosis of childhood tuberculosis and pneumonia will help in assessing the utility of these tests in rapid diagnosis of respiratory infections.
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Affiliation(s)
| | | | | | | | | | | | - Adhin Bhaskar
- ICMR—National Institute for Research in TB, Chennai, India
| | | | | | - Sindhu Hasini
- ICMR—National Institute for Research in TB, Chennai, India
| | - Syed Hissar
- ICMR—National Institute for Research in TB, Chennai, India
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Lemaire JF, Cohn J, Kakayeva S, Tchounga B, Ekouévi PF, Ilunga VK, Ochieng Yara D, Lanje S, Bhamu Y, Haule L, Namubiru M, Nyamundaya T, Berset M, de Souza M, Machekano R, Casenghi M. Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002865. [PMID: 38315700 PMCID: PMC10843113 DOI: 10.1371/journal.pgph.0002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
In 2022, an estimated 1.25 million children <15 years of age developed tuberculosis (TB) worldwide, but >50% remained undiagnosed or unreported. WHO recently recommended integrated and decentralized models of care as an approach to improve access to TB services for children, but evidence remains limited. The Catalyzing Paediatric TB Innovation project (CaP-TB) implemented a multi-pronged intervention to improve TB case finding in children in nine sub-Saharan African countries. The intervention introduced systematic TB screening in different facility-based child-health entry-points, decentralisation of TB diagnosis and management, improved sample collection with access to Xpert® MTB/RIF or MTB/RIF Ultra testing, and implementation of contact investigation. Pre-intervention records were compared with those during intervention to assess effect on paediatric TB cascade of care. The intervention screened 1 991 401 children <15 years of age for TB across 144 health care facilities. The monthly paediatric TB case detection rate increased significantly during intervention versus pre-intervention (+46.0%, 95% CI 36.2-55.8%; p<0.0001), with variability across countries. The increase was greater in the <5 years old compared to the 5-14 years old (+53.4%, 95% CI 35.2-71.9%; p<0.0001 versus +39.9%, 95% CI 27.6-52.2%; p<0.0001). Relative contribution of lower-tier facilities to total case detection rate increased from 37% (71.8/191.8) pre-intervention to 50% (139.9/280.2) during intervention. The majority (89.5%) of children with TB were identified through facility-based intensified case-finding and primarily accessed care through outpatient and inpatient departments. In this multi-country study implemented under real-life conditions, the implementation of integrated and decentralized interventions increased paediatric TB case detection. The increase was driven by lower-tier facilities that serve as the primary point of healthcare contact for most patients. The effect was greater in children < 5 years compared to 5-14 years old, representing an important achievement as the TB detection gap is higher in this subpopulation. (Study number NCT03948698).
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Affiliation(s)
| | - Jennifer Cohn
- Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shirin Kakayeva
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Vicky Kambaji Ilunga
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, République Démocratique du Congo
| | | | - Samson Lanje
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Yusuf Bhamu
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Leo Haule
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Mary Namubiru
- Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda
| | | | - Maude Berset
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Rhoderick Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
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Gan X, Shu Z, Wang X, Yan D, Li J, Ofaim S, Albert R, Li X, Liu B, Zhou X, Barabási AL. Network medicine framework reveals generic herb-symptom effectiveness of traditional Chinese medicine. SCIENCE ADVANCES 2023; 9:eadh0215. [PMID: 37889962 PMCID: PMC10610911 DOI: 10.1126/sciadv.adh0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Understanding natural and traditional medicine can lead to world-changing drug discoveries. Despite the therapeutic effectiveness of individual herbs, traditional Chinese medicine (TCM) lacks a scientific foundation and is often considered a myth. In this study, we establish a network medicine framework and reveal the general TCM treatment principle as the topological relationship between disease symptoms and TCM herb targets on the human protein interactome. We find that proteins associated with a symptom form a network module, and the network proximity of an herb's targets to a symptom module is predictive of the herb's effectiveness in treating the symptom. These findings are validated using patient data from a hospital. We highlight the translational value of our framework by predicting herb-symptom treatments with therapeutic potential. Our network medicine framework reveals the scientific foundation of TCM and establishes a paradigm for understanding the molecular basis of natural medicine and predicting disease treatments.
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Affiliation(s)
- Xiao Gan
- Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology, Nanjing 210044, China
- Network Science Institute, Northeastern University, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Physics, Pennsylvania State University, University Park, PA 16802, USA
- Department of Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Zixin Shu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100063, China
| | - Xinyan Wang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100063, China
| | - Dengying Yan
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100063, China
| | - Jun Li
- Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Shany Ofaim
- Network Science Institute, Northeastern University, Boston, MA 02115, USA
| | - Réka Albert
- Department of Physics, Pennsylvania State University, University Park, PA 16802, USA
- Department of Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Xiaodong Li
- Hubei University of Chinese Medicine, Wuhan 430065, China
- Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Hubei Academy of Chinese Medicine, Wuhan 430061, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xuezhong Zhou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing 100063, China
| | - Albert-László Barabási
- Network Science Institute, Northeastern University, Boston, MA 02115, USA
- Department of Network and Data Science, Central European University, Budapest 1051, Hungary
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Aynalem YA, Getacher L, Ashene YE, Yirga Akalu T, Yideg Yitbarek G, Yeshanew Ayele F, Aklilu D, Marfo EA, Alene T, Shibabaw Shiferaw W. Incidence of tuberculosis and its predictors among under-five children with severe acute malnutrition in North Shoa, Amhara region, Ethiopia: a retrospective follow-up study. Front Pediatr 2023; 11:1134822. [PMID: 37274818 PMCID: PMC10237155 DOI: 10.3389/fped.2023.1134822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/14/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Although tuberculosis (TB) is one of the significant public health challenges in severely malnourished children throughout the globe, it is a severe issue for countries such as Ethiopia, with significant resource limitations. Few studies have examined the incidence of tuberculosis and its predictors among children under five years of age with severe acute malnutrition in developing countries, and there is a paucity of data. This study aimed to estimate the incidence of tuberculosis and its predictors among under-five children with severe acute malnutrition (SAM) in North Shoa, Amhara region, Ethiopia. Methods An institution-based retrospective follow-up study was conducted between January 20, 2017, and June 20, 2019. The sample size was calculated using STATA, which yields a total of 345 charts that were selected with systematic random sampling. Data entry was performed using Epi-data version 4.2 and analyzed with STATA 14. Kaplan-Meier survival curves were computed. Cox proportional hazard models were fitted to detect the determinants of tuberculosis. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with p-values < 0.05 were considered statistically significant. Results The incidence rate of tuberculosis among children under five years of age with SAM was 4.6 per 100 person-day observations (95% CI: 3.29, 8.9). Predictors of TB were a history of contact with known TB cases [AHR: 1.4 (95% CI: 1.00, 2.8], HIV/AIDS [AHR: 3.71 (95% CI: 2.10, 8.71)], baseline pneumonia [AHR: 2.10 (1.76,12)], not supplying zinc at baseline [AHR: 3.1 (1.91, 4.70)], and failed appetite taste at the diagnosis of SAM [AHR: 2.4 (1.35, 3.82)]. Conclusions In this study, the incidence rate of TB was high. Not supplying zinc at baseline, failed appetite taste at the diagnosis of SAM, history of contact with known TB cases, and baseline pneumonia were significant predictors of TB. Prioritizing regular TB screenings, nutritional support, and zinc supplementation for under-five children with SAM should be implemented to reduce the risk of TB.
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Affiliation(s)
- Yared Asmare Aynalem
- College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lemma Getacher
- College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yonatan Eshete Ashene
- Department of Nutrition, North Shoa Zone Health Office, Amhara Regional Health Bureau, Debre Berhan, Ethiopia
| | | | - Getachew Yideg Yitbarek
- Department of Biomedical Sciences (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fanos Yeshanew Ayele
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Dawit Aklilu
- College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Emmanuel Akwasi Marfo
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Tamiru Alene
- Injibara University, College of Medicine and Health Science, Department of Pediatrics and Child Health Nursing, Injibara, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Olbrich L, Nliwasa M, Sabi I, Ntinginya NE, Khosa C, Banze D, Corbett EL, Semphere R, Verghese VP, Michael JS, Graham SM, Egere U, Schaaf HS, Morrison J, McHugh TD, Song R, Nabeta P, Trollip A, Geldmacher C, Hoelscher M, Zar HJ, Heinrich N. Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis. Pediatr Infect Dis J 2023; 42:353-360. [PMID: 36854097 PMCID: PMC10097493 DOI: 10.1097/inf.0000000000003853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. METHODS This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. DISCUSSION As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
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Affiliation(s)
- Laura Olbrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Marriott Nliwasa
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Issa Sabi
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Nyanda E. Ntinginya
- National Institute for Medical Research – Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Denise Banze
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robina Semphere
- Helse Nord Tuberculosis Initiative, Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Valsan P. Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College (CMC), Vellore, India
| | - Joy Sarojini Michael
- Department of Clinical Microbiology, Christian Medical College (CMC), Vellore, India
| | - Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics, Royal Children’s Hospital, Melbourne, Australia
| | - Uzochukwu Egere
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - H. Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Julie Morrison
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College, London, London, United Kingdom
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Pamela Nabeta
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Andre Trollip
- FIND (Foundation for Innovative New Diagnostics), Geneva, Switzerland
| | - Christof Geldmacher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
| | - Heather J. Zar
- Department of Paediatrics & Child Health, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Norbert Heinrich
- From the Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Centre for International Health, University Hospital, LMU Munich, Munich, Germany
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Marcy O, Wobudeya E, Font H, Vessière A, Chabala C, Khosa C, Taguebue JV, Moh R, Mwanga-Amumpaire J, Lounnas M, Mulenga V, Mavale S, Chilundo J, Rego D, Nduna B, Shankalala P, Chirwa U, De Lauzanne A, Dim B, Tiogouo Ngouana E, Folquet Amorrissani M, Cisse L, Amon Tanoh Dick F, Komena EA, Kwedi Nolna S, Businge G, Natukunda N, Cumbe S, Mbekeka P, Kim A, Kheang C, Pol S, Maleche-Obimbo E, Seddon JA, Mao TE, Graham SM, Delacourt C, Borand L, Bonnet M. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:341-351. [PMID: 36395782 DOI: 10.1016/s1473-3099(22)00668-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING Unitaid and L'Initiative. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Olivier Marcy
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France.
| | - Eric Wobudeya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hélène Font
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Aurélia Vessière
- Inserm UMR 1219, IRD EMR 271, University of Bordeaux, Bordeaux, France
| | - Chishala Chabala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Raoul Moh
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | - Manon Lounnas
- MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Veronica Mulenga
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Sandra Mavale
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Josina Chilundo
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Dalila Rego
- Paediatrics Department, José Macamo General Hospital, Maputo, Mozambique
| | | | - Perfect Shankalala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Uzima Chirwa
- Children's Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Agathe De Lauzanne
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | - Lassina Cisse
- Paediatrics Department, Treichville University Teaching Hospital, Abidjan, Côte d'Ivoire
| | | | - Eric A Komena
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Sylvie Kwedi Nolna
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
| | - Gerald Businge
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | | | - Ang Kim
- Pulmonology Department, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Chanrithea Kheang
- Paediatrics Department, Kompong Cham Provincial Hospital, Kompong Cham, Cambodia
| | - Sokha Pol
- Paediatrics Department, Takeo Provincial Hospital, Takeo, Cambodia
| | | | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Department of Infectious Disease, Imperial College London, London, UK
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy, Ministry of Health, Phnom Penh, Cambodia
| | - Stephen M Graham
- University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France; Burnet Institute, Melbourne, VIC, Australia
| | - Christophe Delacourt
- Department of Paediatric Pulmonology, Necker University Teaching Hospital, Paris, France
| | - Laurence Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Maryline Bonnet
- IRD UMI233, Inserm U1175, University of Montpellier, Montpellier, France
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8
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Maugans C, Furin J. A step in the right direction for children with tuberculosis. THE LANCET. INFECTIOUS DISEASES 2023; 23:268-269. [PMID: 36395781 DOI: 10.1016/s1473-3099(22)00690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Chloe Maugans
- The Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, MA, USA
| | - Jennifer Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA 02115, USA.
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9
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Kazi S, Corcoran H, Abo YN, Graham H, Oliwa J, Graham SM. A systematic review of clinical, epidemiological and demographic predictors of tuberculosis in children with pneumonia. J Glob Health 2022; 12:10010. [PMID: 35939347 PMCID: PMC9527007 DOI: 10.7189/jogh.12.10010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Tuberculosis (TB) can present as acute, severe pneumonia in children, but features which distinguish TB from other causes of pneumonia are not well understood. We conducted a systematic review to determine the prevalence and to explore clinical and demographic predictors of TB in children presenting with pneumonia over three decades. Methods We searched for peer-reviewed, English language studies published between 1990 and 2020 that included children aged between 1 month and 17 years with pneumonia and prospectively evaluated for TB. There were 895 abstracts and titles screened, and 72 full text articles assessed for eligibility. Results Thirteen clinical studies, two autopsy studies and one systematic review were included in analyses. Majority of studies were from Africa (12/15) and included children less than five years age. Prevalence of bacteriologically confirmed TB in children with pneumonia ranged from 0.2% to 14.8% (median = 3.7%, interquartile range (IQR) = 5.95) and remained stable over the three decades. TB may be more likely in children with pneumonia if they have a history of close TB contact, HIV infection, malnutrition, age less than one year or failure to respond to empirical antibiotics. However, these features have limited discriminatory value as TB commonly presents as acute severe pneumonia – with a short duration of cough, and clinical and radiographic features indistinguishable from other causes of pneumonia. Approximately half of patients with TB respond to initial empirical antibiotics, presumably due to bacterial co-infection, and follow-up may be critical to detect and treat TB. Conclusion TB should be considered as a potential cause or comorbidity in all children presenting with pneumonia in high burden settings. Clinicians should be alert to the presence of known risk factors for TB and bacteriological confirmation sought whenever possible. Quality data regarding clinical predictors of TB in childhood pneumonia are lacking. Further, prospective research is needed to better understand predictors and prevalence of TB in childhood pneumonia, particularly in TB endemic settings outside of Africa and in older children. Children of all ages with pneumonia should be included in research on improved, point-of-care TB diagnostics to support early case detection and treatment.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Hannah Corcoran
- Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Yara-Natalie Abo
- Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Jacquie Oliwa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Stephen M Graham
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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10
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Pediatric Tuberculosis Management: A Global Challenge or Breakthrough? CHILDREN 2022; 9:children9081120. [PMID: 36010011 PMCID: PMC9406656 DOI: 10.3390/children9081120] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 12/17/2022]
Abstract
Managing pediatric tuberculosis (TB) remains a public health problem requiring urgent and long-lasting solutions as TB is one of the top ten causes of ill health and death in children as well as adolescents universally. Minors are particularly susceptible to this severe illness that can be fatal post-infection or even serve as reservoirs for future disease outbreaks. However, pediatric TB is the least prioritized in most health programs and optimal infection/disease control has been quite neglected for this specialized patient category, as most scientific and clinical research efforts focus on developing novel management strategies for adults. Moreover, the ongoing coronavirus pandemic has meaningfully hindered the gains and progress achieved with TB prophylaxis, therapy, diagnosis, and global eradication goals for all affected persons of varying age bands. Thus, the opening of novel research activities and opportunities that can provide more insight and create new knowledge specifically geared towards managing TB disease in this specialized group will significantly improve their well-being and longevity.
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11
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von Mollendorf C, Berger D, Gwee A, Duke T, Graham SM, Russell FM, Mulholland EK. Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review. J Glob Health 2022; 12:10009. [PMID: 35866332 PMCID: PMC9305023 DOI: 10.7189/jogh.12.10009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.
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Affiliation(s)
- Claire von Mollendorf
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Daria Berger
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen M Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fiona M Russell
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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12
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Carroll A, Maung Maung B, Htun WPP, Watthanaworawit W, Vincenti-Delmas M, Smith C, Sonnenberg P, Nosten F. High burden of childhood tuberculosis in migrants: a retrospective cohort study from the Thailand-Myanmar border. BMC Infect Dis 2022; 22:608. [PMID: 35818023 PMCID: PMC9275033 DOI: 10.1186/s12879-022-07569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of morbidity and mortality in children but epidemiological data are scarce, particularly for hard-to-reach populations. We aimed to identify the risk factors for unsuccessful outcome and TB mortality in migrant children at a supportive residential TB programme on the Thailand-Myanmar border. METHODS We conducted retrospective analysis of routine programmatic data for children (aged ≤ 15 years old) with TB diagnosed either clinically or bacteriologically between 2013 and 2018. Treatment outcomes were described and risk factors for unsuccessful outcome and death were identified using multivariable logistic regression. RESULTS Childhood TB accounted for a high proportion of all TB diagnoses at this TB programme (398/2304; 17.3%). Bacteriological testing was done on a quarter (24.9%) of the cohort and most children were diagnosed on clinical grounds (94.0%). Among those enrolled on treatment (n = 367), 90.5% completed treatment successfully. Unsuccessful treatment outcomes occurred in 42/398 (10.6%) children, comprising 26 (6.5%) lost to follow-up, one (0.3%) treatment failure and 15 (3.8%) deaths. In multivariable analysis, extra-pulmonary TB [adjusted OR (aOR) 3.56 (95% CI 1.12-10.98)], bacteriologically confirmed TB [aOR 6.07 (1.68-21.92)] and unknown HIV status [aOR 42.29 (10.00-178.78)] were independent risk factors for unsuccessful outcome. HIV-positive status [aOR 5.95 (1.67-21.22)] and bacteriological confirmation [aOR 9.31 (1.97-44.03)] were risk factors for death in the secondary analysis. CONCLUSIONS Children bear a substantial burden of TB disease within this migrant population. Treatment success rate exceeded the WHO End TB target of 90%, suggesting that similar vulnerable populations could benefit from the enhanced social support offered by this TB programme, but better child-friendly diagnostics are needed to improve the quality of diagnoses.
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Affiliation(s)
- Amy Carroll
- Institute for Global Health, University College London, Mortimer Market Centre, London, WC1E 6JB, UK.
| | - Banyar Maung Maung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Win Pa Pa Htun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Michele Vincenti-Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Colette Smith
- Institute for Global Health, University College London, Mortimer Market Centre, London, WC1E 6JB, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, Mortimer Market Centre, London, WC1E 6JB, UK
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
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13
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Rojo P, Moraleda C, Tagarro A, Domínguez-Rodríguez S, Castillo LM, Tato LMP, López AS, Manukyan L, Marcy O, Leroy V, Nardone A, Burger D, Bassat Q, Bates M, Moh R, Iroh Tam PY, Mvalo T, Magallhaes J, Buck WC, Sacarlal J, Musiime V, Chabala C, Mujuru HA. Empirical treatment against cytomegalovirus and tuberculosis in HIV-infected infants with severe pneumonia: study protocol for a multicenter, open-label randomized controlled clinical trial. Trials 2022; 23:531. [PMID: 35761406 PMCID: PMC9235074 DOI: 10.1186/s13063-022-06203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pneumonia is the primary cause of death among HIV-infected children in Africa, with mortality rates as high as 35–40% in infants hospitalized with severe pneumonia. Bacterial pathogens and Pneumocystis jirovecii are well known causes of pneumonia-related death, but other important causes such as cytomegalovirus (CMV) and tuberculosis (TB) remain under-recognized and undertreated. The immune response elicited by CMV may be associated with the risk of developing TB and TB disease progression, and CMV may accelerate disease caused both by HIV and TB. Minimally invasive autopsies confirm that CMV and TB are unrecognized causes of death in children with HIV. CMV and TB may also co-infect the same child. The aim of this study is to compare the impact on 15-day and 1-year mortality of empirical treatment against TB and CMV plus standard of care (SoC) versus SoC in HIV-infected infants with severe pneumonia. Methods This is a Phase II-III, open-label randomized factorial (2 × 2) clinical trial, conducted in six African countries. The trial has four arms. Infants from 28 to 365 days of age HIV-infected and hospitalized with severe pneumonia will be randomized (1:1:1:1) to (i) SoC, (ii) valganciclovir, (iii) TB-T, and (iv) TB-T plus valganciclovir. The primary endpoint of the study is all-cause mortality, focusing on the short-term (up to 15 days) and long-term (up to 1 year) mortality. Secondary endpoints include repeat hospitalization, duration of oxygen therapy during initial admission, severe and notable adverse events, adverse reactions, CMV and TB prevalence at enrolment, TB incidence, CMV viral load reduction, and evaluation of diagnostic tests such as GeneXpert Ultra on fecal and nasopharyngeal aspirate samples and urine TB-LAM. Discussion Given the challenges in diagnosing CMV and TB in children and results from previous autopsy studies that show high rates of poly-infection in HIV-infected infants with respiratory disease, this study aims to evaluate a new approach including empirical treatment of CMV and TB for this patient population. The potential downsides of empirical treatment of these conditions include toxicity and medication interactions, which will be evaluated with pharmacokinetics sub-studies. Trial registration ClinicalTrials.gov, NCT03915366, Universal Trial Number U111-1231-4736, Pan African Clinical Trial Registry PACTR201994797961340. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06203-1.
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Affiliation(s)
- Pablo Rojo
- Servicio de Pediatria. Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud (SERMAS), Madrid, Spain.,Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain
| | - Cinta Moraleda
- Servicio de Pediatria. Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud (SERMAS), Madrid, Spain.,Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain
| | - Alfredo Tagarro
- Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain. .,Servicio de Pediatria. Hospital Universitario Infanta Sofia, Servicio Madrileño de Salud (SERMAS), Madrid, Spain. .,Facultad de Ciencias Biomédicas, Universidad Europea de Madrid., Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain
| | - Lola Madrid Castillo
- Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain.,London School of Hygiene & Tropical Medicine (LMC), London, UK
| | - Luis Manuel Prieto Tato
- Servicio de Pediatria. Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud (SERMAS), Madrid, Spain.,Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain
| | - Aranzazu Sancho López
- Pharmacology Unit, Hospital Puerta de Hierro, Servicio, Madrileño de Salud (SERMAS), Madrid, Spain
| | - Lilit Manukyan
- Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC). Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Fundación Biomedica del Hospital Universitario 12 de Octubre (FIB-H12O), Madrid, Spain
| | - Olivier Marcy
- Université de Bordeaux, Inserm U1219, IRD EMR271, Bordeaux Population Health, GHiGS, Bordeaux, France
| | - Valeriane Leroy
- Institut National de la Santé et de la Recherche Médicale (Inserm), University Toulouse 3,CERPOP, Toulouse, France
| | | | - David Burger
- Stichting Katholieke Universiteit- Radboudumc (RUMC), Nijmegen, The Netherlands
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, I, Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,University of Lincoln, Lincoln, United Kingdom
| | | | - Raoul Moh
- Unité Pédagogique de Dermatologie et Infectiologie, UFR Sciences Médicales, Programme PAC-CI, Ivory Coast, Abidjan, Côte d'Ivoire
| | - Pui-Ying Iroh Tam
- Kamuzu University Health Sciences, Blantyre, Malawi.,Malawi-Liverpool Wellcome Programme (MLW), Liverpool School of Tropical Medicine (LSTM), Blantyre, Malawi
| | - Tisungane Mvalo
- Lilongwe Medical Relief Trust (LMRFT), UNC Project Malawi, Lilongwe, Malawi
| | | | - W Chris Buck
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA.,Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Victor Musiime
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Joint Clinical Research Centre, Kampala, Uganda
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14
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Atalell KA, Haile RN, Techane MA. Magnitude of tuberculosis and its associated factors among under-five children admitted with severe acute malnutrition to public hospitals in the city of Dire Dawa, Eastern Ethiopia, 2021: multi-center cross-sectional study. IJID REGIONS 2022; 3:256-260. [PMID: 35755465 PMCID: PMC9216649 DOI: 10.1016/j.ijregi.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of tuberculosis (TB) and its associated factors among children under 5 years of age with severe acute malnutrition. METHODS A multi-center, institution-based, retrospective cross-sectional study was conducted at public hospitals in Dire Dawa City Administration, Eastern Ethiopia from January 1, 2018 to December 30, 2020. A binary logistic regression model was fitted to identify factors associated with the prevalence of TB. RESULTS The overall prevalence of TB among children under 5 years of age admitted with severe acute malnutrition to public hospitals in the city of Dire Dawa, Eastern Ethiopia was 10.39% (95% confidence interval (CI) 7.61-13.73%). Repeated admission (adjusted odds ratio (AOR) 2.5, 95% CI 1.08-6.07), a TB contact history (AOR 3.58, 95% CI 1.21-10.6), pneumonia (AOR 2.8, 95% CI 1.29-6.23), stage IV HIV/AIDS (AOR 4.41, 95% CI 1.29-15.13), and being immunized (AOR 0.19, 95% CI 0.08-0.43) were variables significantly associated with the prevalence of TB. CONCLUSIONS The results of this study showed that the prevalence of TB among under-five children with severe acute malnutrition was high. The prevalence of TB was associated with having HIV/AIDS, having pneumonia, having a TB contact history, admission status, and immunization status. Integrated TB prevention and screening strategies with nutritional rehabilitation care should be implemented.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ribka Nigatu Haile
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Rueda ZV, Aguilar Y, Maya MA, López L, Restrepo A, Garcés C, Morales O, Roya-Pabón C, Trujillo M, Arango C, Copete ÁR, Vera C, Giraldo MR, Herrera M, Vélez LA. Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents. BMC Pediatr 2022; 22:169. [PMID: 35361166 PMCID: PMC8968093 DOI: 10.1186/s12887-022-03235-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03235-z.
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Affiliation(s)
- Zulma Vanessa Rueda
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
| | - Yudy Aguilar
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María Angélica Maya
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lucelly López
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Andrea Restrepo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Carlos Garcés
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Olga Morales
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Claudia Roya-Pabón
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Tuberculosis Clinic, Pima County Health Department, Tucson, USA
| | - Mónica Trujillo
- Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.,Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia.,Departamento de Pediatría, Universidad CES, Medellín, Colombia
| | - Catalina Arango
- Departamento de Pediatría y Puericultura, Grupo Pediaciencias, Universidad de Antioquia UdeA, Medellín, Colombia.,Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Ángela Rocio Copete
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Laboratorio Integrado de Medicina Especializada, Universidad de Antioquia UdeA, IPS Universitaria, Medellin, Colombia
| | - Cristian Vera
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Margarita Rosa Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellín, Colombia
| | - Mariana Herrera
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lázaro A Vélez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, Colombia.,Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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16
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Diagnostic Advances in Childhood Tuberculosis—Improving Specimen Collection and Yield of Microbiological Diagnosis for Intrathoracic Tuberculosis. Pathogens 2022; 11:pathogens11040389. [PMID: 35456064 PMCID: PMC9025862 DOI: 10.3390/pathogens11040389] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 01/26/2023] Open
Abstract
There is no microbiological gold standard for childhood tuberculosis (TB) diagnosis. The paucibacillary nature of the disease, challenges in sample collection in young children, and the limitations of currently available microbiological tests restrict microbiological confirmation of intrathoracic TB to the minority of children. Recent WHO guidelines recommend the use of novel rapid molecular assays as initial diagnostic tests for TB and endorse alternative sample collection methods for children. However, the uptake of these tools in high-endemic settings remains low. In this review, we appraise historic and new microbiological tests and sample collection techniques that can be used for the diagnosis of intrathoracic TB in children. We explore challenges and possible ways to improve diagnostic yield despite limitations, and identify research gaps to address in order to improve the microbiological diagnosis of intrathoracic TB in children.
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17
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Roya-Pabón C, Restrepo A, Morales O, Arango C, Maya MA, Bermúdez M, López L, Garcés C, Trujillo M, Carmona LF, Giraldo MR, Vélez LA, Rueda ZV. Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden. Pediatr Rep 2022; 14:71-80. [PMID: 35225880 PMCID: PMC8883921 DOI: 10.3390/pediatric14010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.
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Affiliation(s)
- Claudia Roya-Pabón
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
- Pima County Health Department, Tuberculosis Clinic, Tucson, AZ 85713, USA
| | - Andrea Restrepo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellin 050010, Colombia; (A.R.); (M.T.)
- Departamento de Pediatría, Universidad CES, Medellin 050010, Colombia
| | - Olga Morales
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - Catalina Arango
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
- Departamento de Pediatría, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia
| | - María Angélica Maya
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia; (M.A.M.); (L.A.V.)
| | - Marcela Bermúdez
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellin 050010, Colombia;
| | - Lucelly López
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
| | - Carlos Garcés
- Grupo Pediaciencias, Departamento de Pediatría y Puericultura, Universidad de Antioquia UdeA, Medellin 050010, Colombia; (C.R.-P.); (O.M.); (C.A.); (C.G.)
| | - Mónica Trujillo
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellin 050010, Colombia; (A.R.); (M.T.)
- Departamento de Pediatría, Universidad CES, Medellin 050010, Colombia
- Section of Pediatric Infectious Diseases, Clínica Universitaria Bolivariana, Medellin 050010, Colombia
| | - Luisa Fernanda Carmona
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellin 050010, Colombia; (L.F.C.); (M.R.G.)
| | - Margarita Rosa Giraldo
- Secretaría Seccional de Salud y Protección Social de Antioquia, Gobernación de Antioquia, Medellin 050010, Colombia; (L.F.C.); (M.R.G.)
| | - Lázaro A. Vélez
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Vicente Fundación, Medellin 050010, Colombia; (M.A.M.); (L.A.V.)
- Grupo Investigador de Problemas en Enfermedades Infecciosas (GRIPE), Facultad de Medicina, Universidad de Antioquia UdeA, Medellin 050010, Colombia;
| | - Zulma Vanessa Rueda
- Grupo de Investigación en Salud Pública, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellin 050031, Colombia;
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Correspondence: ; Tel.: +1-204-789-3678
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18
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Structure-Based Virtual Screening of Benzaldehyde Thiosemicarbazone Derivatives against DNA Gyrase B of Mycobacterium tuberculosis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6140378. [PMID: 34938343 PMCID: PMC8687812 DOI: 10.1155/2021/6140378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Emergence of antibiotic-resistant Mycobacterium tuberculosis (M. tuberculosis) restricts the availability of drugs for the treatment of tuberculosis, which leads to the increased morbidity and mortality of the disease worldwide. There are many intrinsic and extrinsic factors that have been reported for the resistance mechanism. To overcome such mechanisms, chemically synthesized benzaldehyde thiosemicarbazone derivatives were screened against M. tuberculosis to find potential inhibitor for tuberculosis. Such filtering process resulted in compound 13, compound 21, and compound 20 as the best binding energy compounds against DNA gyrase B, an important protein in the replication process. The ADMET prediction has shown the oral bioavailability of the novel compounds.
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19
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Yang G, Wen Y, Chen T, Xu C, Yuan M, Li Y. Comparison of pediatric empyema secondary to tuberculosis or non-tuberculosis community-acquired pneumonia in those who underwent surgery in high TB burden areas. Pediatr Pulmonol 2021; 56:3321-3331. [PMID: 34289260 DOI: 10.1002/ppul.25591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tuberculous empyema (TE) in children is common in high-TB burden and medical resource-limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. METHODS We performed a retrospective study of children with empyema secondary to community-acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non-tuberculosis infection (non-tuberculosis empyema, NTE). RESULTS One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest-tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. CONCLUSION Tuberculosis infection should be screened in management of children with empyema in high-TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource-limited area.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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Seidenberg P, Mwananyanda L, Chipeta J, Kwenda G, Mulindwa JM, Mwansa J, Mwenechanya M, Wa Somwe S, Feikin DR, Haddix M, Hammitt LL, Higdon MM, Murdoch DR, Prosperi C, O’Brien KL, Deloria Knoll M, Thea DM. The Etiology of Pneumonia in HIV-infected Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S50-S58. [PMID: 34448744 PMCID: PMC8448411 DOI: 10.1097/inf.0000000000002649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite recent declines in new pediatric HIV infections and childhood HIV-related deaths, pneumonia remains the leading cause of death in HIV-infected children under 5. We describe the patient population, etiology and outcomes of childhood pneumonia in Zambian HIV-infected children. METHODS As one of the 9 sites for the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age presenting to University Teaching Hospital in Lusaka, Zambia, with World Health Organization-defined severe and very severe pneumonia. Controls frequency-matched on age group and HIV infection status were enrolled from the Lusaka Pediatric HIV Clinics as well as from the surrounding communities. Clinical assessments, chest radiographs (CXR; cases) and microbiologic samples (nasopharyngeal/oropharyngeal swabs, blood, urine, induced sputum) were obtained under highly standardized procedures. Etiology was estimated using Bayesian methods and accounted for imperfect sensitivity and specificity of measurements. RESULTS Of the 617 cases and 686 controls enrolled in Zambia over a 24-month period, 103 cases (16.7%) and 85 controls (12.4%) were HIV infected and included in this analysis. Among the HIV-infected cases, 75% were <1 year of age, 35% received prophylactic trimethoprim-sulfamethoxazole, 13.6% received antiretroviral therapy and 36.9% of caregivers reported knowing their children's HIV status at time of enrollment. A total of 35% of cases had very severe pneumonia and 56.3% had infiltrates on CXR. Bacterial pathogens [50.6%, credible interval (CrI): 32.8-67.2], Pneumocystis jirovecii (24.9%, CrI: 15.5-36.2) and Mycobacterium tuberculosis (4.5%, CrI: 1.7-12.1) accounted for over 75% of the etiologic fraction among CXR-positive cases. Streptococcus pneumoniae (19.8%, CrI: 8.6-36.2) was the most common bacterial pathogen, followed by Staphylococcus aureus (12.7%, CrI: 0.0-25.9). Outcomes were poor, with 41 cases (39.8%) dying in hospital. CONCLUSIONS HIV-infected children in Zambia with severe and very severe pneumonia have poor outcomes, with continued limited access to care, and the predominant etiologies are bacterial pathogens, P. jirovecii and M. tuberculosis.
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Affiliation(s)
- Phil Seidenberg
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Mwananyanda
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Right To Care-Zambia, Lusaka, Zambia
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Department of Microbiology, Lusaka Apex Medical University, Lusaka, Zambia
| | - Musaku Mwenechanya
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Donald M. Thea
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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21
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Claassen-Weitz S, Lim KYL, Mullally C, Zar HJ, Nicol MP. The association between bacteria colonizing the upper respiratory tract and lower respiratory tract infection in young children: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:1262-1270. [PMID: 34111578 PMCID: PMC8437050 DOI: 10.1016/j.cmi.2021.05.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bacteria colonizing the upper respiratory tract (URT) of young children play a key role in the pathogenesis of lower respiratory tract infection (LRTI). OBJECTIVES To systematically review the literature on the association between bacteria colonizing the URT and LRTI among young children. DATA SOURCES MEDLINE, Academic Search Premier, Africa-Wide Information and CINAHL, Scopus and Web of Science. STUDY ELIGIBILITY CRITERIA Studies published between 1923 and 2020, investigating URT bacteria from LRTI cases and controls. PARTICIPANTS Children under 5 years with and without acute LRTI. METHODS Three reviewers independently screened titles, abstracts and full texts. Meta-analysis was done using Mantel-Haenszel fixed- or random-effects models. RESULTS Most eligible studies (41/50) tested nasopharyngeal specimens when investigating URT bacteria. Most studies were of cross-sectional design (44/50). Twenty-four studies were performed in children in lower- or lower-middle-income countries (LMICs). There was higher prevalence of Haemophilus influenzae (pooled OR 1.60; 95% CI 1.23-2.07) and Klebsiella spp. (pooled OR 2.04; 95% CI 1.17-3.55) from URT specimens of cases versus controls. We observed a positive association between the detection of Streptococcus pneumoniae from URT specimens and LRTI after excluding studies where there was more antibiotic treatment prior to sampling in cases vs. controls (pooled OR 1.41; 95% CI 1.04-1.90). High density colonization with S. pneumoniae (>6.9 log10 copies/mL) was associated with an increased risk for LRTI. The associations between both Streptococcus and Haemophilus URT detection and LRTI were supported, at genus level, by 16S rRNA sequencing. Evidence for the role of Moraxella catarrhalis and Staphylococcus aureus was inconclusive. CONCLUSIONS Detection of H. influenzae or Klebsiella spp. in the URT was associated with LRTI, while evidence for association with S. pneumoniae was less conclusive. Longitudinal studies assessing URT microbial communities, together with environmental and host factors are needed to better understand pathogenesis of childhood LRTI.
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Affiliation(s)
- Shantelle Claassen-Weitz
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Katherine Y L Lim
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Christopher Mullally
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SAMRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
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22
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Mwananyanda L, Thea DM, Chipeta J, Kwenda G, Mulindwa JM, Mwenechanya M, Prosperi C, Higdon MM, Haddix M, Hammitt LL, Feikin DR, Murdoch DR, O’Brien KL, Deloria Knoll M, Mwansa J, Wa Somwe S, Seidenberg P. The Etiology of Pneumonia in Zambian Children: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S40-S49. [PMID: 34448743 PMCID: PMC8448410 DOI: 10.1097/inf.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Childhood pneumonia in developing countries is the foremost cause of morbidity and death. Fresh information on etiology is needed, considering the changing epidemiology of pneumonia in the setting of greater availability of effective vaccines, changing antibiotic use and improved access to care. We report here the Zambia site results of the Pneumonia Etiology Research for Child Health study on the etiology of pneumonia among HIV-uninfected children in Lusaka, Zambia. METHODS We conducted a case-control study of HIV-uninfected children age 1-59 months admitted with World Health Organization-defined severe or very severe pneumonia to a large tertiary care hospital in Lusaka. History, physical examination, chest radiographs (CXRs), blood cultures and nasopharyngeal/oropharyngeal swabs were obtained and tested by polymerase chain reaction and routine microbiology for the presence of 30 bacteria and viruses. From age and seasonally matched controls, we tested blood and nasopharyngeal/oropharyngeal samples. We used the Pneumonia Etiology Research for Child Health integrated analysis to determine the individual and population etiologic fraction for individual pathogens as the cause of pneumonia. RESULTS Among the 514 HIV-uninfected case children, 208 (40.5%) had abnormal CXRs (61 of 514 children were missing CXR), 8 (3.8%) of which had positive blood cultures. The overall mortality was 16.0% (82 deaths). The etiologic fraction was highest for respiratory syncytial virus [26.1%, 95% credible interval (CrI): 17.0-37.7], Mycobacterium tuberculosis (12.8%, 95% CrI: 4.3-25.3) and human metapneumovirus (12.8%, CrI: 6.1-21.8). CONCLUSIONS Childhood pneumonia in Zambia among HIV-uninfected children is most frequently caused by respiratory syncytial virus, M. tuberculosis and human metapneumovirus, and the mortality remains high.
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Affiliation(s)
- Lawrence Mwananyanda
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Right To Care-Zambia, Lusaka, Zambia
| | - Donald M. Thea
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Musaku Mwenechanya
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- Department of Microbiology, Lusaka Apex Medical University, Lusaka, Zambia
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Phil Seidenberg
- From the Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
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23
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Fritschi N, Wind A, Hammer J, Ritz N. Subclinical tuberculosis in children: diagnostic strategies for identification reported in a 6-year national prospective surveillance study. Clin Infect Dis 2021; 74:678-684. [PMID: 34410343 DOI: 10.1093/cid/ciab708] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subclinical tuberculosis (TB) is well recognized and defined as a disease state with absent or non-recognized symptoms. The study identifies factors associated with subclinical TB and diagnostic strategies in a low-burden, high-resource country. METHODS Data was collected between December 2013 to November 2019 through the Swiss Pediatric Surveillance Unit (SPSU). Children with culture/molecular confirmed TB, or who were treated with ≥3 anti-mycobacterial drugs, were included. RESULTS A total of 138 (80%) children with TB disease were included in the final analysis, of which 43 (31%) were subclinical. The median age of children with subclinical compared to symptomatic TB was 3.7(IQR 2.2 to 7) and 9.7(IQR 2.7 to 14.3) years, respectively (p=0.003). The cause of investigation for TB was recorded in 31/43 (72.1%) of children with subclinical TB, and included contact exposure in 25 (80.6%). In children with subclinical TB, diagnosis was made by a combination of the following abnormal/confirming results: culture/molecular + immunodiagnostic + chest radiography in 12 (27.9%), immunodiagnostic + chest radiography in 19 (44.2%), culture/molecular + chest radiography in 2 (4.7%), culture + immunodiagnostic in 1 (2.3%), chest radiography only in 8 (18.6%) and immunodiagnostic only in 1 (2.3%) case. CONCLUSION A notable proportion of children with TB had subclinical disease. This highlights the importance of non-symptom-based TB case finding in exposed children and refugees from high-TB-prevalence settings. TB screening in these asymptomatic children should therefore include a combination of immunodiagnostic testing and imaging followed by culture and molecular testing.
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Affiliation(s)
- Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel
| | - Ante Wind
- Unity Health Care, Washington DC, USA
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Australia
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Surface-enhanced Raman spectroscopy for comparison of serum samples of typhoid and tuberculosis patients of different stages. Photodiagnosis Photodyn Ther 2021; 35:102426. [PMID: 34217869 DOI: 10.1016/j.pdpdt.2021.102426] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surface-enhanced Raman spectroscopy (SERS) is a reliable tool for the identification and differentiation of two different human pathological conditions sharing the same symptomology, typhoid and tuberculosis (TB). OBJECTIVES To explore the potential of surface-enhanced Raman spectroscopy for differentiation of two different diseases showing the same symptoms and analysis by principal component analysis (PCA) and partial least square discriminate analysis (PLS-DA). METHODS Serum samples of clinically diagnosed typhoid and tuberculosis infected individuals were analyzed and differentiated by SERS using silver nanoparticles (Ag NPs) as a SERS substrate. For this purpose, the collected serum samples were analyzed under the SERS instrument and unique SERS spectra of typhoid and tuberculosis were compared showing notable spectral differences in protein, lipid and carbohydrates features. Different stages of the diseased class of typhoid (Early acute and late acute stage) and tuberculosis (Pulmonary and extra-pulmonary stage) were compared with each other and with healthy human serum samples, which were significantly separated. Moreover, SERS data was analyzed using multivariate data analysis techniques including principal component analysis (PCA) and partial least square discriminate analysis (PLS-DA) and differences were so prominent to observe. RESULTS SERS Spectral data of typhoid and tuberculosis showed clear differences and were significantly separated using PCA. SERS spectral data of both stages of typhoid and tuberculosis were separated according to 1st principle component. Moreover, by analyzing data using partial least square discriminate analysis, differentiation of two disease classes were considered more valid with a 100% value of sensitivity, specificity and accuracy. CONCLUSION SERS can be employed for identification and comparison of two different human pathological conditions sharing same symptomology.
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Vonasek B, Ness T, Takwoingi Y, Kay AW, van Wyk SS, Ouellette L, Marais BJ, Steingart KR, Mandalakas AM. Screening tests for active pulmonary tuberculosis in children. Cochrane Database Syst Rev 2021; 6:CD013693. [PMID: 34180536 PMCID: PMC8237391 DOI: 10.1002/14651858.cd013693.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Globally, children under 15 years represent approximately 12% of new tuberculosis cases, but 16% of the estimated 1.4 million deaths. This higher share of mortality highlights the urgent need to develop strategies to improve case detection in this age group and identify children without tuberculosis disease who should be considered for tuberculosis preventive treatment. One such strategy is systematic screening for tuberculosis in high-risk groups. OBJECTIVES To estimate the sensitivity and specificity of the presence of one or more tuberculosis symptoms, or symptom combinations; chest radiography (CXR); Xpert MTB/RIF; Xpert Ultra; and combinations of these as screening tests for detecting active pulmonary childhood tuberculosis in the following groups. - Tuberculosis contacts, including household contacts, school contacts, and other close contacts of a person with infectious tuberculosis. - Children living with HIV. - Children with pneumonia. - Other risk groups (e.g. children with a history of previous tuberculosis, malnourished children). - Children in the general population in high tuberculosis burden settings. SEARCH METHODS We searched six databases, including the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, on 14 February 2020 without language restrictions and contacted researchers in the field. SELECTION CRITERIA Cross-sectional and cohort studies where at least 75% of children were aged under 15 years. Studies were eligible if conducted for screening rather than diagnosing tuberculosis. Reference standards were microbiological (MRS) and composite reference standard (CRS), which may incorporate symptoms and CXR. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality using QUADAS-2. We consolidated symptom screens across included studies into groups that used similar combinations of symptoms as follows: one or more of cough, fever, or poor weight gain and one or more of cough, fever, or decreased playfulness. For combination of symptoms, a positive screen was the presence of one or more than one symptom. We used a bivariate model to estimate pooled sensitivity and specificity with 95% confidence intervals (CIs) and performed analyses separately by reference standard. We assessed certainty of evidence using GRADE. MAIN RESULTS Nineteen studies assessed the following screens: one symptom (15 studies, 10,097 participants); combinations of symptoms (12 studies, 29,889 participants); CXR (10 studies, 7146 participants); and Xpert MTB/RIF (2 studies, 787 participants). Several studies assessed more than one screening test. No studies assessed Xpert Ultra. For 16 studies (84%), risk of bias for the reference standard domain was unclear owing to concern about incorporation bias. Across other quality domains, risk of bias was generally low. Symptom screen (verified by CRS) One or more of cough, fever, or poor weight gain in tuberculosis contacts (4 studies, tuberculosis prevalence 2% to 13%): pooled sensitivity was 89% (95% CI 52% to 98%; 113 participants; low-certainty evidence) and pooled specificity was 69% (95% CI 51% to 83%; 2582 participants; low-certainty evidence). Of 1000 children where 50 have pulmonary tuberculosis, 339 would be screen-positive, of whom 294 (87%) would not have pulmonary tuberculosis (false positives); 661 would be screen-negative, of whom five (1%) would have pulmonary tuberculosis (false negatives). One or more of cough, fever, or decreased playfulness in children aged under five years, inpatient or outpatient (3 studies, tuberculosis prevalence 3% to 13%): sensitivity ranged from 64% to 76% (106 participants; moderate-certainty evidence) and specificity from 37% to 77% (2339 participants; low-certainty evidence). Of 1000 children where 50 have pulmonary tuberculosis, 251 to 636 would be screen-positive, of whom 219 to 598 (87% to 94%) would not have pulmonary tuberculosis; 364 to 749 would be screen-negative, of whom 12 to 18 (2% to 3%) would have pulmonary tuberculosis. One or more of cough, fever, poor weight gain, or tuberculosis close contact (World Health Organization four-symptom screen) in children living with HIV, outpatient (2 studies, tuberculosis prevalence 3% and 8%): pooled sensitivity was 61% (95% CI 58% to 64%; 1219 screens; moderate-certainty evidence) and pooled specificity was 94% (95% CI 86% to 98%; 201,916 screens; low-certainty evidence). Of 1000 symptom screens where 50 of the screens are on children with pulmonary tuberculosis, 88 would be screen-positive, of which 57 (65%) would be on children who do not have pulmonary tuberculosis; 912 would be screen-negative, of which 19 (2%) would be on children who have pulmonary tuberculosis. CXR (verified by CRS) CXR with any abnormality in tuberculosis contacts (8 studies, tuberculosis prevalence 2% to 25%): pooled sensitivity was 87% (95% CI 75% to 93%; 232 participants; low-certainty evidence) and pooled specificity was 99% (95% CI 68% to 100%; 3281 participants; low-certainty evidence). Of 1000 children, where 50 have pulmonary tuberculosis, 63 would be screen-positive, of whom 19 (30%) would not have pulmonary tuberculosis; 937 would be screen-negative, of whom 6 (1%) would have pulmonary tuberculosis. Xpert MTB/RIF (verified by MRS) Xpert MTB/RIF, inpatient or outpatient (2 studies, tuberculosis prevalence 1% and 4%): sensitivity was 43% and 100% (16 participants; very low-certainty evidence) and specificity was 99% and 100% (771 participants; moderate-certainty evidence). Of 1000 children, where 50 have pulmonary tuberculosis, 31 to 69 would be Xpert MTB/RIF-positive, of whom 9 to 19 (28% to 29%) would not have pulmonary tuberculosis; 969 to 931 would be Xpert MTB/RIF-negative, of whom 0 to 28 (0% to 3%) would have tuberculosis. Studies often assessed more symptoms than those included in the index test and symptom definitions varied. These differences complicated data aggregation and may have influenced accuracy estimates. Both symptoms and CXR formed part of the CRS (incorporation bias), which may have led to overestimation of sensitivity and specificity. AUTHORS' CONCLUSIONS We found that in children who are tuberculosis contacts or living with HIV, screening tests using symptoms or CXR may be useful, but our review is limited by design issues with the index test and incorporation bias in the reference standard. For Xpert MTB/RIF, we found insufficient evidence regarding screening accuracy. Prospective evaluations of screening tests for tuberculosis in children will help clarify their use. In the meantime, screening strategies need to be pragmatic to address the persistent gaps in prevention and case detection that exist in resource-limited settings.
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Affiliation(s)
- Bryan Vonasek
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tara Ness
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexander W Kay
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine , Houston, Texas, USA
| | - Susanna S van Wyk
- Centre for Evidence-based Health Care, Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Section of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine , Houston, Texas, USA
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Factors associated with negative pleural adenosine deaminase results in the diagnosis of childhood pleural tuberculosis. BMC Infect Dis 2021; 21:473. [PMID: 34034670 PMCID: PMC8152150 DOI: 10.1186/s12879-021-06209-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Until now, the influential factors associated with pleural adenosine deaminase (ADA) activity among children remain unclear. This retrospective study was therefore conducted aiming to investigate the factors associated with negative pleural ADA results in the diagnosis of childhood pleural tuberculosis (TB). Methods Between January 2006 and December 2019, children patients with definite or possible pleural TB were recruited for potential analysis. Then, patients were stratified into two categories: negative pleural ADA results group (experimental group, ≤40 U/L) and positive pleural ADA results group (control group, > 40 U/L). Univariate and multivariate logistic regression analyses were performed to estimate risk factors for negative pleural ADA results. Results A total of 84 patients with pleural TB were recruited and subsequently classified as experimental (n = 17) and control groups (n = 67). Multivariate analysis (Hosmer–Lemeshow goodness-of-fit test: χ2 = 1.881, df = 6, P = 0.930) revealed that variables, such as chest pain (age-adjusted OR = 0.0510, 95% CI: 0.004, 0.583), pleural total protein (≤45.3 g/L, age-adjusted OR = 27.7, 95% CI: 2.5, 307.7), pleural lactate dehydrogenase (LDH, ≤505 U/L, age-adjusted OR = 59.9, 95% CI: 4.2, 857.2) and blood urea nitrogen (≤3.2 mmol/L, age-adjusted OR = 32.0, 95% CI: 2.4, 426.9), were associated with negative pleural ADA results when diagnosing childhood pleural TB. Conclusion Our findings demonstrated that chest pain, pleural total protein, pleural LDH, and blood urea nitrogen were associated with a negative pleural ADA result for the diagnosis of pleural TB among children. When interpreting pleural ADA levels in children with these characteristics, a careful clinical assessment is required for the pleural TB diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06209-1.
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Vessière A, Font H, Gabillard D, Adonis-Koffi L, Borand L, Chabala C, Khosa C, Mavale S, Moh R, Mulenga V, Mwanga-Amumpere J, Taguebue JV, Eang MT, Delacourt C, Seddon JA, Lounnas M, Godreuil S, Wobudeya E, Bonnet M, Marcy O. Impact of systematic early tuberculosis detection using Xpert MTB/RIF Ultra in children with severe pneumonia in high tuberculosis burden countries (TB-Speed pneumonia): a stepped wedge cluster randomized trial. BMC Pediatr 2021; 21:136. [PMID: 33743621 PMCID: PMC7980598 DOI: 10.1186/s12887-021-02576-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background In high tuberculosis (TB) burden settings, there is growing evidence that TB is common in children with pneumonia, the leading cause of death in children under 5 years worldwide. The current WHO standard of care (SOC) for young children with pneumonia considers a diagnosis of TB only if the child has a history of prolonged symptoms or fails to respond to antibiotic treatments. As a result, many children with TB-associated severe pneumonia are currently missed or diagnosed too late. We therefore propose a diagnostic trial to assess the impact on mortality of adding the systematic early detection of TB using Xpert MTB/RIF Ultra (Ultra) performed on nasopharyngeal aspirates (NPA) and stool samples to the WHO SOC for children with severe pneumonia, followed by immediate initiation of anti-TB treatment in children testing positive on any of the samples. Methods TB-Speed Pneumonia is a pragmatic stepped-wedge cluster randomized controlled trial conducted in six countries with high TB incidence rate (Côte d’Ivoire, Cameroon, Uganda, Mozambique, Zambia and Cambodia). We will enrol 3780 children under 5 years presenting with WHO-defined severe pneumonia across 15 hospitals over 18 months. All hospitals will start managing children using the WHO SOC for severe pneumonia; one hospital will be randomly selected to switch to the intervention every 5 weeks. The intervention consists of the WHO SOC plus rapid TB detection on the day of admission using Ultra performed on 1 nasopharyngeal aspirate and 1 stool sample. All children will be followed for 3 months, with systematic trial visits at day 3, discharge, 2 weeks post-discharge, and week 12. The primary endpoint is all-cause mortality 12 weeks after inclusion. Qualitative and health economic evaluations are embedded in the trial. Discussion In addition to testing the main hypothesis that molecular detection and early treatment will reduce TB mortality in children, the strength of such pragmatic research is that it provides some evidence regarding the feasibility of the intervention as part of routine care. Should this intervention be successful, safe and well tolerated, it could be systematically implemented at district hospital level where children with severe pneumonia are referred. Trial registration ClinicalTrials.gov, NCT03831906. Registered 6 February 2019.
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Affiliation(s)
- Aurélia Vessière
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France.
| | - Hélène Font
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
| | - Delphine Gabillard
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
| | | | - Laurence Borand
- Epidemiology and Public Health Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Chishala Chabala
- University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Celso Khosa
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Sandra Mavale
- Paediatrics Department, Maputo Central Hospital, Maputo, Mozambique
| | - Raoul Moh
- Programme PAC-CI, CHU de Treichville, Abidjan, Ivory Coast
| | - Veronica Mulenga
- Children's Hospital, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Mao Tan Eang
- National Center for Tuberculosis and Leprosy (CENAT/NTP), Ministry of Health, Phnom Penh, Cambodia
| | - Christophe Delacourt
- Department of Paediatric Pulmonology, Necker University Teaching Hospital, Paris, France
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.,Department of Infectious Diseases, Imperial College London, London, UK
| | | | | | - Eric Wobudeya
- Makerere University-Johns Hopkins University Research Collaboration (MU-JHU) Care Ltd, Kampala, Uganda
| | - Maryline Bonnet
- IRD UMI233/Inserm U1175, University of Montpellier, Montpellier, France
| | - Olivier Marcy
- University of Bordeaux, Inserm, Institut de Recherche pour le Développement (IRD), UMR 1219, Bordeaux, France
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Simen-Kapeu A, Reserva ME, Ekpini RE. Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:S47-S64. [PMID: 33727320 PMCID: PMC7971379 DOI: 10.9745/ghsp-d-20-00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA). Though evidence-based cost-effective interventions that are predicted to prevent up to one-third of maternal, newborn, and child health complications and deaths with universal coverage have been identified, more than 50% of people living in rural areas or from poor families still do not have access to these interventions in resource-constrained settings. METHODS We conducted a multicountry systematic analysis of bottlenecks and proposed solutions to strengthen community health systems through a series of collaborative workshops in 22 countries in WCA. Countries were categorized by their under-5 mortality rate (U5MR) to assess specificities related to reported challenges. We also reviewed existing data on selected health system tracer interventions to analyze country profiles. RESULTS The bottlenecks identified as severe or very severe were related to health financing (19 countries, 86%), essential medical technology and products (16 countries, 73%), integrated health service delivery (14 countries, 64%), and community ownership and partnerships (self-reported by 14 countries, 64%). Only the integrated service delivery was self-reported as a severe challenge by countries with high U5MR. The issue of human resources for community health was one of the least reported challenges. CONCLUSION In WCA, strengthening community health systems as part of PHC revitalization efforts should focus on increasing health financing and innovative investments, strengthening the logistics management system, and fostering community ownership and partnerships. Countries with high U5MR should also reinforce integrated service delivery approaches through innovation. Government actions galvanized by global and regional ongoing initiatives should be sustained to ensure that no one is left behind.
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Affiliation(s)
- Aline Simen-Kapeu
- United Nations Children's Fund, West and Central Regional Office, Dakar, Senegal.
| | | | - Rene Ehounou Ekpini
- United Nations Children's Fund, West and Central Regional Office, Dakar, Senegal
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Risk factors associated with surgical intervention in childhood pleural tuberculosis. Sci Rep 2021; 11:3084. [PMID: 33542398 PMCID: PMC7862429 DOI: 10.1038/s41598-021-82936-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022] Open
Abstract
Surgical intervention use is common in the management of childhood pleural tuberculosis (TB), however, its associated risk factors remain unclear. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of pleural TB were included for the analysis. Surgical intervention was defined as debridement (such as breaking loculations), decortication, and thoracic surgery (such as lobectomy or segmental resection). Patients undergoing surgery were included as surgical group, without surgery were classified as non-surgical group, surgical risk factors were then estimated. Univariate and multivariate logistic regression analysis were performed to evaluate the risk factors for surgical interventions. A total of 154 children diagnosed as pleural TB (definite, 123 cases; possible, 31 cases) were included in our study. Of them, 29 patients (18.8%) were classified as surgical group and 125 patients (81.2%) were classified as non-surgical group. Surgical treatments were analyzed in 29 (18.8%) patients, including debridement (n = 4), decortication (n = 21), and thoracic surgery (n = 4). Further multivariate analysis revealed that empyema (age- and sex-adjusted OR = 27.3, 95% CI 8.6, 87.1; P < 0.001) and frequency of hospitalization (age- and sex-adjusted OR = 1.53, 95% CI 1.11, 2.11; P < 0.01) were associated with the use of surgical interventions in children with pleural TB. In China, surgical interventions are still required in a significant proportion of children with pleural TB, and the surgical risk is found to be associated with the frequency of hospitalization and empyema. These findings may be helpful to improve the management of children with pleural TB and minimize the risk of poor outcomes.
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Githinji L, Zar HJ. Respiratory Complications in Children and Adolescents with Human Immunodeficiency Virus. Pediatr Clin North Am 2021; 68:131-145. [PMID: 33228928 DOI: 10.1016/j.pcl.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory complications comprise a large proportion of the burden of mortality and morbidity in children with human immunodeficiency virus (HIV). HIV-associated lower respiratory tract infection (LRTI) has declined in incidence with early diagnosis and use of antiretroviral therapy (ART) but is widespread in areas with limited access to ART. HIV-exposed uninfected infants have a higher risk of LRTI early in life than unexposed infants. Pulmonary tuberculosis (PTB) presenting as acute or chronic disease is common in highly TB endemic areas. Chronic lung disease is common; preceding LRTI, PTB or late initiation of ART are risk factors.
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Affiliation(s)
- Leah Githinji
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, South Africa MRC Unit on Child & Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, ICH Building, Klipfontein Road, Rondebosch 7700, South Africa.
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Oliwa JN, Nzinga J, Masini E, van Hensbroek MB, Jones C, English M, Van't Hoog A. Improving case detection of tuberculosis in hospitalised Kenyan children-employing the behaviour change wheel to aid intervention design and implementation. Implement Sci 2020; 15:102. [PMID: 33239055 PMCID: PMC7687703 DOI: 10.1186/s13012-020-01061-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya, and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel. METHODS We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included (i) what is the problem we are trying to solve; (ii) what behaviours are we trying to change and in what way; (iii) what will it take to bring about desired change; (iv) what types of interventions are likely to bring about desired change; (v) what should be the specific intervention content and how should this be implemented? RESULTS The following behaviour change intervention functions were identified as follows: (i) training: imparting practical skills; (ii) modelling: providing an example for people to aspire/imitate; (iii) persuasion: using communication to induce positive or negative feelings or stimulate action; (iv) environmental restructuring: changing the physical or social context; and (v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and workflow restructuring with role specification. CONCLUSION The intervention components were selected for their effectiveness (from literature), affordability, acceptability, and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
- Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nairobi, Kenya.
- The Academic Medical Centre, Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | - Michaël Boele van Hensbroek
- The Academic Medical Centre, Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Caroline Jones
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Anja Van't Hoog
- The Academic Medical Centre, Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Nicol MP, Zar HJ. Advances in the diagnosis of pulmonary tuberculosis in children. Paediatr Respir Rev 2020; 36:52-56. [PMID: 32624357 PMCID: PMC7686111 DOI: 10.1016/j.prrv.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
Major challenges still exist in the accurate diagnosis of tuberculosis in children. Algorithms based on clinical and radiological features remain in widespread use despite poor performance. Newer molecular diagnostics allow for rapid identification of TB and detection of drug-resistance in a subset of children, but lack sensitivity. Molecular testing of multiple specimens, including non-traditional specimen types, such as nasopharyngeal aspirates and stool and urine, may improve sensitivity, but the optimal combination of specimens requires further research. Novel tests under development or evaluation include a urine lipoarabinomannan test with improved sensitivity and a range of biomarkers measured from stimulated or unstimulated peripheral blood.
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Affiliation(s)
- Mark P Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia.
| | - Heather J Zar
- Department of Paediatrics and Child Health, and SA-MRC Unit on Child & Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Martins-Melo FR, Bezerra JMT, Barbosa DS, Carneiro M, Andrade KB, Ribeiro ALP, Naghavi M, Werneck GL. The burden of tuberculosis and attributable risk factors in Brazil, 1990-2017: results from the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18:10. [PMID: 32993691 PMCID: PMC7526097 DOI: 10.1186/s12963-020-00203-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/19/2020] [Indexed: 01/29/2023] Open
Abstract
Background Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). Methods This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). Results In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269–349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645–202,394), while 87,957 DALYs (95% UI: 50,624–146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex–age-specific TB burden was highest among males and in children under-1 year and the age groups 45–59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. Conclusions GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.
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Affiliation(s)
- Francisco Rogerlândio Martins-Melo
- Federal Institute of Education, Science and Technology of Ceará, Rua Francisco da Rocha Martins, S/N, Pabussu, Caucaia, CE, 61609-090, Brazil.
| | - Juliana Maria Trindade Bezerra
- Epidemiology of Infectious and Parasitic Diseases Laboratory, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - David Soeiro Barbosa
- Epidemiology of Infectious and Parasitic Diseases Laboratory, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Mariângela Carneiro
- Epidemiology of Infectious and Parasitic Diseases Laboratory, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Kleydson Bonfim Andrade
- National Tuberculosis Programme, Department of Chronic Infectious Diseases and STI, Secretariat of Health Surveillance, Brazilian Ministry of Health, SRTVN, Quadra 701, Via W5 Norte, Lote D, Edifício PO700, 6° andar, Brasília, DF, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas, Faculty of Medicine, Federal University of Minas Gerais, Avenida Prof. Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, WA, 98121, USA
| | - Guilherme Loureiro Werneck
- Institute of Studies in Public Health, Federal University of Rio de Janeiro, Avenida Horácio Macedo, S/N, Ilha do Fundão - Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil.,Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua São Francisco Xavier 524, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
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Berra TZ, Assis ISD, Arroyo LH, Arcoverde MAM, Alves JD, Campoy LT, Alves LS, Crispim JDA, Bruce ATI, Alves YM, Lima Dos Santos F, da Costa Uchôa SA, Fiorati RC, Lapão L, Arcêncio RA. Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study. BMJ Open 2020; 10:e034074. [PMID: 32819980 PMCID: PMC7443304 DOI: 10.1136/bmjopen-2019-034074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants. METHODS Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified. RESULTS A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25). CONCLUSIONS The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
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Affiliation(s)
- Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Luiz Henrique Arroyo
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Josilene Dália Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Laura Terenciani Campoy
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | | | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | | | - Regina Celia Fiorati
- Department of Maternal-Infant and Public Health, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Luis Lapão
- International Public Health and Biostatistics, Universidade Nova de Lisboa, Lisboa, Portugal
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Oliwa JN, Odero SA, Nzinga J, van Hensbroek MB, Jones C, English M, van’t Hoog A. Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting - modern diagnostics meet age-old challenges. BMC Health Serv Res 2020; 20:708. [PMID: 32738917 PMCID: PMC7395417 DOI: 10.1186/s12913-020-05588-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings. METHODS This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. RESULTS At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical). CONCLUSION We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Michaël Boele van Hensbroek
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Caroline Jones
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Anja van’t Hoog
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Vonasek B, Ness T, Takwoingi Y, Kay AW, van Wyk SS, Ouellette L, Marais BJ, Steingart KR, Mandalakas AM. Screening tests for active pulmonary tuberculosis in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2020. [DOI: 10.1002/14651858.cd013693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bryan Vonasek
- The Global Tuberculosis Program, Texas Children’s Hospital, Section of Global and Immigrant Health, Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - Tara Ness
- The Global Tuberculosis Program, Texas Children’s Hospital, Section of Global and Immigrant Health, Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research; University of Birmingham; Birmingham UK
| | - Alexander W Kay
- The Global Tuberculosis Program, Texas Children’s Hospital, Section of Global and Immigrant Health, Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
| | - Susanna S van Wyk
- Centre for Evidence-based Health Care, Epidemiology and Biostatistics, Department of Global Health; Organisation:Faculty of Medicine and Health Sciences, Stellenbosch University; Cape Town South Africa
| | | | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity; University of Sydney; Sydney Australia
| | - Karen R Steingart
- Honorary Research Fellow; Department of Clinical Sciences, Liverpool School of Tropical Medicine; Liverpool UK
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children’s Hospital, Section of Global and Immigrant Health, Department of Pediatrics; Baylor College of Medicine; Houston Texas USA
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Abstract
BACKGROUND Infants are a target population for new tuberculosis (TB) vaccines. TB incidence estimates are needed to guide the design of trials. To determine the TB incidence and cohort retention among young children using comprehensive diagnostic methods in a high burden area. METHODS Infants 0-42 days were enrolled. Through 4 monthly follow-up and unscheduled (sick) visits up to the age of 2 years, infants with presumptive TB based on a history of contact, TB symptoms or pre-determined hospitalization criteria were admitted to a case verification ward. Two induced sputa and gastric aspirates were collected for culture and GeneXpert. Mantoux and HIV tests were done. Clinical management was based on the Keith Edwards score. Cases were classified into microbiologically confirmed or radiologic, diagnosed by blinded expert assessment. Cox regression was used to identify risk factors for incident TB and study retention. RESULTS Of 2900 infants enrolled, 927 (32%) developed presumptive TB, 737/927 (80%) were investigated. Sixty-nine TB cases were diagnosed (bacteriologic and radiologic). All TB incidence was 2/100 person-years of observation (pyo) (95% CI: 1.65-2.65). Nine were bacteriologic cases, incidence 0.3/100 pyo. The radiologic TB incidence was 1.82/100 pyo. Bacteriologic TB was associated with infant HIV infection, higher Keith Edwards scores. Completeness of 4-month vaccinations and HIV infection were positively associated with retention. CONCLUSIONS TB incidence was high. An all TB endpoint would require a sample size of a few thousand children, but tens of thousands, when limited to bacteriologic TB.
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Valvi C, Chandanwale A, Khadse S, Kulkarni R, Kadam D, Kinikar A, Joshi S, Lokhande R, Pardeshi G, Garg P, Gupte N, Jain D, Suryavanshi N, Golub JE, Shankar A, Gupta A, Dhumal G, Deluca A, Bollinger RC. Delays and barriers to early treatment initiation for childhood tuberculosis in India. Int J Tuberc Lung Dis 2020; 23:1090-1099. [PMID: 31627774 DOI: 10.5588/ijtld.18.0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.
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Affiliation(s)
- C Valvi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Chandanwale
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Khadse
- Rajiv Gandhi Medical College and Chatrapati Shivaji Maharaj Hospital, Kalwa, Thane
| | - R Kulkarni
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - S Joshi
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - G Pardeshi
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
| | - P Garg
- Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shankar
- Department of Environmental Health and Engineering
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD
| | - G Dhumal
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, India
| | - A Deluca
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R C Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD
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Van Brusselen D, Simons E, Luendo T, Habarugira D, Ngowa J, Mitutso NN, Moluh Z, Steenssens M, Seguin R, Vochten H, Ngabo L, Isaakidis P, Ferlazzo G. Improving pediatric TB diagnosis in North Kivu (DR Congo), focusing on a clinical algorithm including targeted Xpert MTB/RIF on gastric aspirates. Confl Health 2020; 14:26. [PMID: 32467723 PMCID: PMC7227188 DOI: 10.1186/s13031-020-00281-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background The incidence of tuberculosis (TB) in the Democratic Republic of the Congo (DRC) is 323/100,000. A context of civil conflict, internally displaced people and mining activities suggests a higher regional TB incidence in North Kivu. Médecins Sans Frontières (MSF) supports the General Reference Hospital of Masisi, North Kivu, covering a population of 520,000, with an elevated rate of pediatric malnutrition. In July 2017, an adapted MSF pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates (GAs), was implemented. The aim of this study was to evaluate whether the introduction of this clinical pediatric TB diagnostic algorithm influenced the number of children started on TB treatment. Methods We performed a retrospective analysis of pediatric TB cases started on treatment in the inpatient therapeutic feeding centre (ITFC) and the pediatric ward. We compared data collected in the second half (July to December) of 2016 (before introduction of the new diagnostic algorithm) and the second half of 2017. For the outcome variables the difference between the two years was calculated by a Pearson Chi-square test. Results In 2017, 94 GAs were performed, compared to none in 2016. Twelve percent (11/94) of samples were Xpert MTB/RIF positive. Sixty-eight children (2.9% of total exits) aged between 3 months and 15 years started TB treatment in 2017, compared to 19 (1.4% of total exits) in 2016 (p 0.002). The largest increase in pediatric TB diagnoses in 2017 occurred in patients with a negative Xpert MTB/RIF result, but clinically highly suggestive of TB according to the newly introduced diagnostic algorithm. Fifty-two (3.1%) children under five years old started treatment in 2017, as compared to 14 (1.3%) in 2016 (p 0.004). The increase was less pronounced and not statistically significant in older patients: sixteen children (2.6%) above 5 years old started TB treatment in 2017 as compared to five (1.3%) in 2016 (p 0.17). Conclusion After the introduction of an adapted clinical pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates, we observed a significant increase in the number of children – especially under 5 years old – started on TB treatment, mostly on clinical grounds. Increased ‘clinician awareness’ of pediatric TB likely played an important role.
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Affiliation(s)
- Daan Van Brusselen
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo.,Department of (Tropical) Pediatrics, GZA Hospitals, Oosterveldlaan, 22 Antwerp, Belgium.,4Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Corneel Heymanslaan 10, entrance 42 (building K3), 4th floor, Ghent, Belgium
| | - Erica Simons
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Tony Luendo
- Bureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo
| | - Delphine Habarugira
- Bureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo
| | - Jimmy Ngowa
- Bureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo
| | - Nadine Neema Mitutso
- Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Zakari Moluh
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Mieke Steenssens
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Rachelle Seguin
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Hilde Vochten
- 1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.,Médecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo
| | - Lucien Ngabo
- Bureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo
| | - Petros Isaakidis
- 6Médecins Sans Frontières, Southern African Medical Unit (SAMU), Médecins Sans Frontières, Zurich House, 7th Floor, 70 Fox Street, Marshalltown, Johannesburg, South Africa
| | - Gabriella Ferlazzo
- 6Médecins Sans Frontières, Southern African Medical Unit (SAMU), Médecins Sans Frontières, Zurich House, 7th Floor, 70 Fox Street, Marshalltown, Johannesburg, South Africa
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Banu EA, Nechita A, Elkan-Cojocaru EM, Baciu G, Manole A, Chelaru L. Risk of tuberculosis in low birth weight children from East Romania. Arch Med Sci 2020; 16:162-166. [PMID: 32051720 PMCID: PMC6963146 DOI: 10.5114/aoms.2018.78768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the context of the global tuberculosis (TB) burden, children represent 10% of all cases, with high incidence rates still reported by many regions worldwide. The study aim was to determine whether there is a correlation between TB clinical diagnosis and low birth weight in children at various ages. MATERIAL AND METHODS The study was conducted between 2010 and 2014, on a group of 1783 pediatric patients and a subgroup of 137 pediatric patients with low birth weight (LBW). Data were collected from patients' records and hospital statistical reports then processed using MS Excel 2010 and SPSS v.22. RESULTS The subgroup of LBW patients accounted for 7.68% of all recorded cases. Girls were predominant (total M: F = 0.95; LBW group M: F = 0.91, p < 0.05), most from an urban area (total U: R = 1.29; LBW subgroup U: R = 1.36, p < 0.05). 22.59% of LBW subgroup children were infants aged of 0-12 months. The youngest age at TB diagnosis was 1 month and the lowest weight was 700 g. ANOVA regression for LBW and age at TB diagnosis, showed a multiple R value of 0.0256, p = 0.7659 (F = 0.7659, 95% CI). CONCLUSIONS The correlation between clinical diagnosis of tuberculosis in children at various ages and their low birth weight was positive but was not statistically significant. However, this research hypothesis should be tested in further studies on larger population groups, due to the current public health context of "End TB", promoted worldwide.
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Affiliation(s)
- Elena Ariela Banu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi; “Sf. Ioan” Emergency Clinic Hospital for Children, Galaţi, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi; “Sf. Ioan” Emergency Clinic Hospital for Children, Galaţi, Romania
| | - Eva Maria Elkan-Cojocaru
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi; “Sf. Ioan” Emergency Clinic Hospital for Children, Galaţi, Romania
| | - Ginel Baciu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi; “Sf. Ioan” Emergency Clinic Hospital for Children, Galaţi, Romania
| | - Alina Manole
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Liliana Chelaru
- Department of Morphological Sciences, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
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Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev 2019; 32:3-9. [PMID: 31422032 PMCID: PMC6990397 DOI: 10.1016/j.prrv.2019.06.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review epidemiology, aetiology and management of childhood pneumonia in low-and-middle-income countries. DESIGN Review of published English literature between 2013 and 2019. RESULTS Pneumonia remains a major cause of morbidity and mortality. Risk factors include young age, malnutrition, immunosuppression, tobacco smoke or air pollution exposure. Better methods for specimen collection and molecular diagnostics have improved microbiological diagnosis, indicating that pneumonia results from several organisms interacting. Induced sputum increases microbiologic yield for Bordetella pertussis or Mycobacterium tuberculosis, which has been associated with pneumonia in high TB prevalence areas. The proportion of cases due to Streptococcus pneumoniae and Haemophilus influenzae b has declined with new conjugate vaccines; Staphylococcus aureus and H. influenzae non-type b are the commonest bacterial pathogens; viruses are the most common pathogens. Effective interventions comprise antibiotics, oxygen and non-invasive ventilation. New vaccines have reduced severity and incidence of disease, but disparities exist in uptake. CONCLUSION Morbidity and mortality from childhood pneumonia has decreased but a considerable preventable burden remains. Widespread implementation of available, effective interventions and development of novel strategies are needed.
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MESH Headings
- Age Factors
- Air Pollution/statistics & numerical data
- Anti-Bacterial Agents/therapeutic use
- Child Nutrition Disorders/epidemiology
- Child, Preschool
- Developing Countries
- Haemophilus Infections/epidemiology
- Haemophilus Infections/microbiology
- Haemophilus Infections/prevention & control
- Haemophilus Infections/therapy
- Humans
- Infant
- Infant, Newborn
- Noninvasive Ventilation/methods
- Oxygen Inhalation Therapy/methods
- Pneumonia/epidemiology
- Pneumonia/microbiology
- Pneumonia/prevention & control
- Pneumonia/therapy
- Pneumonia, Pneumococcal/epidemiology
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/prevention & control
- Pneumonia, Pneumococcal/therapy
- Pneumonia, Staphylococcal/epidemiology
- Pneumonia, Staphylococcal/microbiology
- Pneumonia, Staphylococcal/therapy
- Risk Factors
- Tobacco Smoke Pollution/statistics & numerical data
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/prevention & control
- Tuberculosis, Pulmonary/therapy
- Vaccines/therapeutic use
- Whooping Cough/epidemiology
- Whooping Cough/microbiology
- Whooping Cough/prevention & control
- Whooping Cough/therapy
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Department of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Dai Y, Shan W, Yang Q, Guo J, Zhai R, Tang X, Tang L, Tan Y, Cai Y, Chen X. Biomarkers of iron metabolism facilitate clinical diagnosis in M ycobacterium tuberculosis infection. Thorax 2019; 74:1161-1167. [PMID: 31611342 PMCID: PMC6902069 DOI: 10.1136/thoraxjnl-2018-212557] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perturbed iron homeostasis is a risk factor for tuberculosis (TB) progression and an indicator of TB treatment failure and mortality. Few studies have evaluated iron homeostasis as a TB diagnostic biomarker. METHODS We recruited participants with TB, latent TB infection (LTBI), cured TB (RxTB), pneumonia (PN) and healthy controls (HCs). We measured serum levels of three iron biomarkers including serum iron, ferritin and transferrin, then established and validated our prediction model. RESULTS We observed and verified that the three iron biomarker levels correlated with patient status (TB, HC, LTBI, RxTB or PN) and with the degree of lung damage and bacillary load in patients with TB. We then built a TB prediction model, neural network (NNET), incorporating the data of the three iron biomarkers. The model showed good performance for diagnosis of TB, with 83% (95% CI 77 to 87) sensitivity and 86% (95% CI 83 to 89) specificity in the training data set (n=663) and 70% (95% CI 58 to 79) sensitivity and 92% (95% CI 86 to 96) specificity in the test data set (n=220). The area under the curves (AUCs) of the NNET model to discriminate TB from HC, LTBI, RxTB and PN were all >0.83. Independent validation of the NNET model in a separate cohort (n=967) produced an AUC of 0.88 (95% CI 0.85 to 0.91) with 74% (95% CI 71 to 77) sensitivity and 92% (95% CI 87 to 96) specificity. CONCLUSIONS The established NNET TB prediction model discriminated TB from HC, LTBI, RxTB and PN in a large cohort of patients. This diagnostic assay may augment current TB diagnostics.
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Affiliation(s)
- Youchao Dai
- Guangdong Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China.,Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wanshui Shan
- Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Qianting Yang
- Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Jiubiao Guo
- Guangdong Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
| | - Rihong Zhai
- Department of Preventive Medicine, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xiaoping Tang
- Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yaoju Tan
- State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou, China
| | - Yi Cai
- Guangdong Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
| | - Xinchun Chen
- Guangdong Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
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Zawedde-Muyanja S, Nakanwagi A, Dongo JP, Sekadde MP, Nyinoburyo R, Ssentongo G, Detjen AK, Mugabe F, Nakawesi J, Karamagi Y, Amuge P, Kekitiinwa A, Graham SM. Decentralisation of child tuberculosis services increases case finding and uptake of preventive therapy in Uganda. Int J Tuberc Lung Dis 2019; 22:1314-1321. [PMID: 30355411 DOI: 10.5588/ijtld.18.0025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. OBJECTIVE To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. METHODS In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Before-and-after analysis as well as comparisons with non-intervention districts were used to evaluate impact on caseload and treatment outcomes. RESULTS By December 2016, the average number of children (age < 15 years) diagnosed with TB increased from 45 to 108 per quarter. The proportion of child TB among all TB cases increased from 8.8% to 15%, and the proportion completing treatment increased from 65% to 82%. Of 2270 child TB contacts screened, 55 (2.4%) were diagnosed with TB. Of 910 eligible child contacts, 670 (74%) started preventive therapy, 569 (85%) of whom completed therapy. CONCLUSION The strengthening of child TB services at peripheral health facilities in Uganda was associated with increased case finding, improved treatment outcomes and the successful implementation of contact screening and management.
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Affiliation(s)
- S Zawedde-Muyanja
- International Union Against Tuberculosis and Lung Disease, Paris, France;, The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala
| | - A Nakanwagi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J P Dongo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M P Sekadde
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala, Baylor College of Children's Medical Foundation, Kampala
| | | | - G Ssentongo
- Baylor College of Children's Medical Foundation, Kampala
| | - A K Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France;, United Nations Children's Fund, New York, USA
| | - F Mugabe
- The National Tuberculosis and Leprosy Programme, Ministry of Health, Kampala
| | | | | | - P Amuge
- Baylor College of Children's Medical Foundation, Kampala
| | - A Kekitiinwa
- Baylor College of Children's Medical Foundation, Kampala
| | - S M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France;, Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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45
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Sousa GJB, Silva JCDO, Queiroz TVD, Bravo LG, Brito GCB, Pereira ADS, Pereira MLD, Santos LKXD. Clinical and epidemiological features of tuberculosis in children and adolescents. Rev Bras Enferm 2019; 72:1271-1278. [PMID: 31531651 DOI: 10.1590/0034-7167-2018-0172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical and epidemiological features of tuberculosis in children and adolescents in an infectious diseases reference hospital. METHOD A documental and retrospective study was carried out with 88 medical files in an infectious diseases reference hospital in the state of Ceará. Data were analyzed by univariate, bivariate and multivariate approaches. RESULTS It was found that, depending on the tuberculosis type, its manifestations may vary. The logistic regression model considered only pulmonary tuberculosis due to a number of observations and included female sex (95% CI: 1.4-16.3), weight loss (95% CI: 1.8-26.3), bacilloscopic screening (95% CI: 1.5-16.6) and sputum collected (95% CI: 1.4-19.4) as possible predictors. CONCLUSIONS Children and adolescents present different manifestations of the disease depending on the tuberculosis type that affects them. Knowing the most common features of each condition could enhance early diagnosis and, consequently, result in adequate treatment and care.
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46
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Reuter A, Hughes J, Furin J. Challenges and controversies in childhood tuberculosis. Lancet 2019; 394:967-978. [PMID: 31526740 DOI: 10.1016/s0140-6736(19)32045-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 01/03/2023]
Abstract
Children bear a substantial burden of suffering when it comes to tuberculosis. Ironically, they are often left out of the scientific and public health advances that have led to important improvements in tuberculosis diagnosis, treatment, and prevention over the past decade. This Series paper describes some of the challenges and controversies in paediatric tuberculosis, including the epidemiology and treatment of tuberculosis in children. Two areas in which substantial challenges and controversies exist (ie, diagnosis and prevention) are explored in more detail. This Series paper also offers possible solutions for including children in all efforts to end tuberculosis, with a focus on ensuring that the proper financial and human resources are in place to best serve children exposed to, infected with, and sick from all forms of tuberculosis.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Jennifer Hughes
- Desmond Tutu Tuberculosis Center, Stellenbosch University, Stellenbosch, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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47
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Martinez L, le Roux DM, Barnett W, Stadler A, Nicol MP, Zar HJ. Tuberculin skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: a birth cohort study from Cape Town, South Africa. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 2:46-55. [PMID: 29457055 PMCID: PMC5810304 DOI: 10.1016/s2352-4642(17)30149-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Tuberculosis is a leading cause of global childhood mortality. However, the epidemiology and burden of tuberculosis in infancy is not well understood. We aimed to investigate tuberculin skin test conversion and tuberculosis in the Drakenstein Child Health study, a South African birth cohort in a community in which tuberculosis incidence is hyperendemic. Methods In this prospective birth cohort study, we enrolled pregnant women older than 18 years who were between 20 and 28 weeks' gestation and who were attending antenatal care in a peri-urban, impoverished South African setting. We followed up their children for tuberculosis from birth until April 1, 2017, or age 5 years. All children received BCG vaccination at birth. Tuberculin skin tests were administered to children at 6, 12, 24, 36, 48, and 60 months of age, and at the time of a lower respiratory tract infection. An induration reaction of 10 mm or more was considered to be a tuberculin skin test conversion. To prevent boosting, we censored children with a reactive, negative tuberculin skin test. Findings Among 915 mother-child pairs (201 [22%] HIV-positive mothers and two [<1%] HIV-positive children), 147 (16%) children had tuberculin skin test conversion, with increasing cumulative hazard with age (0·08 at 6 months, 0·17 at 12 months, 0·22 at 24 months, and 0·37 at age 36 months). For every 100 child-years, the incidence was 11·8 (95% CI 10·0-13·8) for tuberculin skin test conversion, 2·9 (2·4-3·7) for all diagnosed tuberculosis, and 0·7 (0·4-1·0) for microbiologically confirmed tuberculosis. Isoniazid preventive therapy was effective in averting disease progression (adjusted hazard ratio 0·22, 95% CI 0·08-0·63; p<0·0001). Children with a lower respiratory tract infection were significantly more likely to also have tuberculosis than were those without one (2·27, 1·42-3·62; p<0·0001). Interpretation Greater focus should be placed on the first years of life as a period of high burden of transmission and clinical expression of tuberculosis infection and disease. Multifaceted interventions, such as isoniazid preventive therapy and tuberculosis screening of infants with LRTIs, beginning early in life, are needed in high-burden settings. Funding Bill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - David M le Roux
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Attie Stadler
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Oliwa JN, Gathara D, Ogero M, van Hensbroek MB, English M, van’t Hoog A. Diagnostic practices and estimated burden of tuberculosis among children admitted to 13 government hospitals in Kenya: An analysis of two years' routine clinical data. PLoS One 2019; 14:e0221145. [PMID: 31483793 PMCID: PMC6726144 DOI: 10.1371/journal.pone.0221145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND True burden of tuberculosis (TB) in children is unknown. Hospitalised children are low-hanging fruit for TB case detection as they are within the system. We aimed to explore the process of recognition and investigation for childhood TB using a guideline-linked cascade of care. METHODS This was an observational study of 42,107 children admitted to 13 county hospitals in Kenya from 01Nov 15-31Oct 16, and 01Nov 17-31Oct 18. We estimated those that met each step of the cascade, those with an apparent (or "Working") TB diagnosis and modelled associations with TB tests amongst guideline-eligible children. RESULTS 23,741/42,107 (56.4%) met step 1 of the cascade (≥2 signs and symptoms suggestive of TB). Step 2(further screening of history of TB contact/full respiratory exam) was documented in 14,873/23,741 (62.6%) who met Step 1. Step 3(chest x-ray or Mantoux test) was requested in 2,451/14,873 (16.5%) who met Step 2. Step 4(≥1 bacteriological test) was requested in 392/2,451 (15.9%) who met Step 3. Step 5("Working TB" diagnosis) was documented in 175/392 (44.6%) who met Step 4. Factors associated with request of TB tests in patients who met Step 1 included: i) older children [AOR 1.19(CI 1.09-1.31)]; ii) co-morbidities of HIV, malnutrition or pneumonia [AOR 3.81(CI 3.05-4.75), 2.98(CI 2.69-3.31) and 2.98(CI 2.60-3.40) respectively]; iii) sicker children, readmitted/referred [AOR 1.24(CI 1.08-1.42) and 1.15(CI 1.04-1.28) respectively]. "Working TB" diagnosis was made in 2.9%(1,202/42,107) of all admissions and 0.2%(89/42,107) were bacteriologically-confirmed. CONCLUSIONS More than half of all paediatric admissions had symptoms associated with TB and nearly two-thirds had more specific history documented. Only a few amongst them got TB tests requested. TB was diagnosed in 2.9% of all admissions but most were inadequately investigated. Major challenges remain in identifying and investigating TB in children in hospitals with access to Xpert MTB/RIF and a review is needed of existing guidelines.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- University of Nairobi, Department of Paediatrics and Child Health, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Morris Ogero
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Michaël Boele van Hensbroek
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- Oxford University, Nuffield Department of Medicine, Oxford, England, United Kingdom
| | - Anja van’t Hoog
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
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Wang B, Li M, Ma H, Han F, Wang Y, Zhao S, Liu Z, Yu T, Tian J, Dong D, Peng Y. Computed tomography-based predictive nomogram for differentiating primary progressive pulmonary tuberculosis from community-acquired pneumonia in children. BMC Med Imaging 2019; 19:63. [PMID: 31395012 PMCID: PMC6688341 DOI: 10.1186/s12880-019-0355-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background To investigate the value of predictive nomogram in optimizing computed tomography (CT)-based differential diagnosis of primary progressive pulmonary tuberculosis (TB) from community-acquired pneumonia (CAP) in children. Methods This retrospective study included 53 patients with clinically confirmed pulmonary TB and 62 patients with CAP. Patients were grouped at random according to a 3:1 ratio (primary cohort n = 86, validation cohort n = 29). A total of 970 radiomic features were extracted from CT images and key features were screened out to build radiomic signatures using the least absolute shrinkage and selection operator algorithm. A predictive nomogram was developed based on the signatures and clinical factors, and its performance was assessed by the receiver operating characteristic curve, calibration curve, and decision curve analysis. Results Initially, 5 and 6 key features were selected to establish a radiomic signature from the pulmonary consolidation region (RS1) and a signature from lymph node region (RS2), respectively. A predictive nomogram was built combining RS1, RS2, and a clinical factor (duration of fever). Its classification performance (AUC = 0.971, 95% confidence interval [CI]: 0.912–1) was better than the senior radiologist’s clinical judgment (AUC = 0.791, 95% CI: 0.636-0.946), the clinical factor (AUC = 0.832, 95% CI: 0.677–0.987), and the combination of RS1 and RS2 (AUC = 0.957, 95% CI: 0.889–1). The calibration curves indicated a good consistency of the nomogram. Decision curve analysis demonstrated that the nomogram was useful in clinical settings. Conclusions A CT-based predictive nomogram was proposed and could be conveniently used to differentiate pulmonary TB from CAP in children. Electronic supplementary material The online version of this article (10.1186/s12880-019-0355-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bei Wang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Min Li
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, No. 3-11 Wenhua Road, Shenyang, China.,CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No.95 Zhongguancun East Road, Beijing, 100190, China
| | - He Ma
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, No. 3-11 Wenhua Road, Shenyang, China
| | - Fangfang Han
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, No. 3-11 Wenhua Road, Shenyang, China
| | - Yan Wang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi Road, Beijing, 100045, China
| | - Zhimin Liu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Tong Yu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No.95 Zhongguancun East Road, Beijing, 100190, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, No. 37 Xueyuan Road, Beijing, 100191, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No.95 Zhongguancun East Road, Beijing, 100190, China. .,University of Chinese Academy of Sciences, No.19 Yuquan Road, Beijing, China.
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Beijing, 100045, China. .,CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No.95 Zhongguancun East Road, Beijing, 100190, China.
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Whittaker E, López-Varela E, Broderick C, Seddon JA. Examining the Complex Relationship Between Tuberculosis and Other Infectious Diseases in Children. Front Pediatr 2019; 7:233. [PMID: 31294001 PMCID: PMC6603259 DOI: 10.3389/fped.2019.00233] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Millions of children are exposed to tuberculosis (TB) each year, many of which become infected with Mycobacterium tuberculosis. Most children can immunologically contain or eradicate the organism without pathology developing. However, in a minority, the organism overcomes the immunological constraints, proliferates and causes TB disease. Each year a million children develop TB disease, with a quarter dying. While it is known that young children and those with immunodeficiencies are at increased risk of progression from TB infection to TB disease, our understanding of risk factors for this transition is limited. The most immunologically disruptive process that can happen during childhood is infection with another pathogen and yet the impact of co-infections on TB risk is poorly investigated. Many diseases have overlapping geographical distributions to TB and affect similar patient populations. It is therefore likely that infection with viruses, bacteria, fungi and protozoa may impact on the risk of developing TB disease following exposure and infection, although disentangling correlation and causation is challenging. As vaccinations also disrupt immunological pathways, these may also impact on TB risk. In this article we describe the pediatric immune response to M. tuberculosis and then review the existing evidence of the impact of co-infection with other pathogens, as well as vaccination, on the host response to M. tuberculosis. We focus on the impact of other organisms on the risk of TB disease in children, in particularly evaluating if co-infections drive host immune responses in an age-dependent way. We finally propose priorities for future research in this field. An improved understanding of the impact of co-infections on TB could assist in TB control strategies, vaccine development (for TB vaccines or vaccines for other organisms), TB treatment approaches and TB diagnostics.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
| | - Elisa López-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Claire Broderick
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - James A. Seddon
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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