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Elsingergy MM, Naidoo J, Baker G, Zar HJ, Lucas S, Andronikou S. Comparison of chest radiograph findings in ambulatory and hospitalized children with pulmonary tuberculosis. Pediatr Radiol 2023; 53:1765-1772. [PMID: 37423915 DOI: 10.1007/s00247-023-05707-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The diagnosis of childhood tuberculosis (TB) is, in many instances, solely reliant on chest radiographs (CXRs), as they are often the only diagnostic tool available, especially in TB-endemic areas. Accuracy and reliability of CXRs for detecting TB lymphadenopathy may vary between groups depending on severity of presentation and presence of parenchymal disease, which may obscure visualization. OBJECTIVE To compare CXR findings in ambulatory versus hospitalized children with laboratory confirmed pulmonary TB versus other lower respiratory tract infections (LRTI) and test inter-rater agreement for these findings. MATERIALS AND METHODS Retrospective review, by two pediatric radiologists, of CXRs performed on children < 12 years old referred for evaluation of LRTI with clinical suspicion of pulmonary TB in inpatient and outpatient settings. Each radiologist commented on imaging findings of parenchymal changes, lymphadenopathy, airway compression and pleural effusion. Frequency of imaging findings was compared between patients based on location and diagnosis and inter-rater agreement was determined. Accuracy of radiographic diagnosis was compared to laboratory testing which served as the gold standard. RESULTS The number of enrolled patients was 181 (54% males); 69 (38%) were ambulatory and 112 (62%) were hospitalized. Of those enrolled, 87 (48%) were confirmed to have pulmonary TB, while 94 (52%) were other LRTI controls. Lymphadenopathy and airway compression were more common in TB patients than other LRTI controls, regardless of patient location. Parenchymal changes and pleural effusion were more common in hospitalized than ambulatory patients, regardless of patient diagnosis. Agreement for parenchymal changes was higher in the hospitalized group (kappa [κ] = 0.75), while agreement for lymphadenopathy (κ = 0.65) and airway compression (κ = 0.68) was higher in the ambulatory group. The specificity of CXRs for TB diagnosis (> 75%) was higher than the sensitivity (< 50%) for both ambulatory and hospitalized groups. CONCLUSION Higher frequency of parenchymal changes among hospitalized children may conceal specific imaging findings of TB such as lymphadenopathy, contributing to the poor reliability of CXRs. Despite this, the high specificity of CXRs shown in our results is encouraging for continued use of radiographs for TB diagnosis in both settings.
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Affiliation(s)
- Mohamed M Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Jaishree Naidoo
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Gregory Baker
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, and SA-MRC Unit On Child & Adolescent Health University of Cape Town, Cape Town, South Africa
| | - Susan Lucas
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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2
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Marcy O, Goyet S, Borand L, Msellati P, Ung V, Tejiokem M, Do Chau G, Ateba-Ndongo F, Ouedraogo AS, Dim B, Perez P, Asselineau J, Carcelain G, Blanche S, Delacourt C, Godreuil S. Tuberculosis Diagnosis in HIV-Infected Children: Comparison of the 2012 and 2015 Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. J Pediatric Infect Dis Soc 2022; 11:108-114. [PMID: 34902033 DOI: 10.1093/jpids/piab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no gold standard for tuberculosis diagnosis in children. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children were proposed by international experts in 2012 and updated in 2015. We aimed to compare the 2012 and 2015 Clinical Case Definitions in HIV-infected children with suspected tuberculosis. METHODS We enrolled HIV-infected children with suspected tuberculosis in Burkina Faso, Cambodia, Cameroon, and Vietnam (ANRS [Agence Nationale de Recherches sur le SIDA et les hépatites virales] 12229 PAANTHER [Pediatric Asian African Network for Tuberculosis and HIV Research] 01 Study). We classified children using the 2012 and 2015 Case Definitions considering as tuberculosis cases those with confirmed tuberculosis and those with probable and unconfirmed tuberculosis in the 2012 and the 2015 classifications, respectively. We assessed agreement between both classifications. RESULTS Of 438 children enrolled, 197 (45.0%) children were classified as tuberculosis (45 confirmed, 152 probable) using the 2012 Case Definition and 251 (57.3%) were classified as tuberculosis (55 confirmed, 196 unconfirmed) using the 2015 classification. Inter-classification agreement for tuberculosis diagnosis was 364/438, 83.1%, with a kappa statistic of 0.667 (95% confidence interval 0.598-0.736). Of 152 children with probable tuberculosis (2012), 142 (93.4%) were considered as tuberculosis by the 2015 version and 10 (6.6%) as unlikely tuberculosis including 9 with spontaneous clinical improvement. Of 132 possible tuberculosis (2012), 58 (43.9%) were reclassified as tuberculosis (2015). CONCLUSIONS Agreement between the 2 versions of the Case Definition was substantial but more children were considered as tuberculosis using the 2015 version. Spontaneous symptom resolution reinforces both confidence in the "unlikely" category as being children without tuberculosis and the importance of the clinician's treatment decision in the study.
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Affiliation(s)
- Olivier Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,U1219 Bordeaux Population Health, University of Bordeaux, Inserm, IRD, Bordeaux, France
| | - Sophie Goyet
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Philippe Msellati
- UMI 233-U1175 TransVIHMI, IRD, Université de Montpellier, Montpellier, France
| | - Vibol Ung
- TB/HIV Department, National Pediatric Hospital, Phnom Penh, Cambodia.,University of Health Sciences, Phnom Penh, Cambodia
| | - Mathurin Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | - Giang Do Chau
- Planning Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | | | - Abdoul Salam Ouedraogo
- Centre Hospitalier Universitaire Souro Sanou, Service de Microbiologie, Bobo Dioulasso, Burkina Faso
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Paul Perez
- Department of Public Health, Bordeaux University Hospital, Bordeaux, France.,Centre d'Investigation Clinique - Epidémiologie Clinique, CIC-EC 1401, Bordeaux, France
| | - Julien Asselineau
- Department of Public Health, Bordeaux University Hospital, Bordeaux, France.,Centre d'Investigation Clinique - Epidémiologie Clinique, CIC-EC 1401, Bordeaux, France
| | | | - Stéphane Blanche
- Unité d'Immunologie Hématologie Rhumatologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, CHU de Montpellier, Montpellier, France.,MIVEGEC, Univ Montpellier, CNRS, IRD, Montpellier, France
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3
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Babafemi EO, Cherian BP, Ouma B, Mogoko GM. Paediatric tuberculosis diagnosis using Mycobacterium tuberculosis real-time polymerase chain reaction assay: a systematic review and meta-analysis. Syst Rev 2021; 10:278. [PMID: 34706779 PMCID: PMC8554997 DOI: 10.1186/s13643-021-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of paediatric tuberculosis (TB) is key to manage the disease and to control and prevent its transmission. Collection of quality sputum samples without invasion methods from paediatrics (age < 16 years) with presumptive pulmonary tuberculosis (PTB) remains a challenge. Thus, the aim of this meta-analysis was to assess the overall accuracy of a real-time polymerase chain reaction (RT-PCR)-based assay, for routine diagnosis of MTB in different samples from paediatrics with active pulmonary and extra-pulmonary tuberculosis using mycobacterial culture as the gold standard in clinical microbiology laboratories. METHODS We conducted a systematic review and meta-analysis to examine the diagnostic test accuracy of RT-PCR based assay for the detection of MTB in paediatric clinical samples. A systematic literature search was performed for publications in any language. MEDLINE via PubMed, EMBASE, and Web of Science were among 9 bibliographic databases searched from August 2019 until November 2020. Bivariate random-effects model of meta-analysis were performed to generate pooled summary estimates (95% CIs) for overall accuracy of RT-PCR based assay compared to mycobacterial culture as the reference standard. RESULTS Of the 1592 candidate studies, twenty-one eligible studies met our inclusion criteria. In total, the review and meta-analysis included 5536 (3209 PTB and 2327 EPTB). Summary estimates for pulmonary TB (11 studies) were as follows: sensitivity 56 (95% CI 51-62), specificity 97 (95% CI 96-98) and summary estimates for extra-pulmonary TB (10 studies) were as follows: sensitivity 87 (95% CI 82-91)) specificity 100 (95% CI 99-100). There was significant heterogeneity in sensitivity and specificity among the enrolled studies (p < 0.001). CONCLUSIONS Our results suggested that the RT-PCR based assay could be a useful test for the diagnosis of paediatrics TB with high sensitivity and specificity in low-income/high-burden and upper medium income/low-burden settings. From the study, RT-PCR assay demonstrated a high degree of sensitivity for extra-pulmonary TB and good sensitivity for pulmonary TB which is an important factor in achieving effective global control and for patient management in terms of initiating early and appropriate anti-tubercular therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018104052.
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Affiliation(s)
| | - Benny P Cherian
- Liverpool John Moores University-City Campus, Liverpool, Merseyside, UK
| | - Beatrice Ouma
- Liverpool John Moores University-City Campus, Liverpool, Merseyside, UK
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Gutiérrez-González LH, Juárez E, Carranza C, Carreto-Binaghi LE, Alejandre A, Cabello-Gutiérrrez C, Gonzalez Y. Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis. Infect Drug Resist 2021; 14:929-946. [PMID: 33727834 PMCID: PMC7955028 DOI: 10.2147/idr.s295798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of tuberculosis (TB) in children is difficult because of the low sensitivity and specificity of traditional microbiology techniques in this age group. Whereas in adults the culture of Mycobacterium tuberculosis (M. tuberculosis), the gold standard test, detects 80% of positive cases, it only detects around 30-40% of cases in children. The new methods based on the immune response to M. tuberculosis infection could be affected by many factors. It is necessary to evaluate the medical record, clinical features, presence of drug-resistant M. tuberculosis strains, comorbidities, and BCG vaccination history for the diagnosis in children. There is no ideal biomarker for all TB cases in children. A new strategy based on personalized diagnosis could be used to evaluate specific molecules produced by the host immune response and make therapeutic decisions in each child, thereby changing standard immunological signatures to personalized signatures in TB. In this way, immune diagnosis, prognosis, and the use of potential immunomodulators as adjunct TB treatments will meet personalized treatment.
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Affiliation(s)
| | - Esmeralda Juárez
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Claudia Carranza
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Laura E Carreto-Binaghi
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Alejandro Alejandre
- Pediatric Clinic, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Carlos Cabello-Gutiérrrez
- Virology and Mycology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
| | - Yolanda Gonzalez
- Microbiology Department, National Institute for Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico
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5
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Mutabazi SA, Jumanne S, Mpondo BC, Mnzava DP. Prevalence of culture positive Tuberculosis and utility of a clinical diagnostic tool for the diagnosis of Tuberculosis among HIV Infected Children attending HIV/AIDS Care and Treatment in Dodoma Municipality, Central Tanzania. Int J Infect Dis 2020; 96:593-599. [PMID: 32505876 DOI: 10.1016/j.ijid.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the modified Keith Edwards TB clinical diagnostic tool among HIV infected children. METHODS Cross sectional study of 252 HIV infected children < 15 years old suspected with TB at four HIV/AIDS Care Clinics in Dodoma, Tanzania from November 2018 - March 2019. The modified Keith Edwards TB clinical diagnostic tool was compared to gastric aspirates, lymphnode aspirates or sputum gene x-pert MTB/RIF and TB culture. Sensitivity, specificity, negative and positive predictive value of the clinical tool were determined. Data was analyzed using SPSS version 25. RESULTS Out of 252 children evaluated, 13.5% (34/252) had TB using the clinical diagnostic tool and 5.2% (13/252) had culture positive TB. The sensitivity of the clinical tool was 76.9%, specificity of 90%. Culture positive TB predictors were lymphadenopathy (AOR 13.74, 95%CI (3.86 - 48.86) p value < 0.001), weight loss (AOR 3.19,95%CI (1.38 - 7.36) p value 0.007), and difficulty breathing (AOR 7.25, 95%CI (1.54 - 34.16) p value 0.012). CONCLUSION The utility of the modified Keith Edwards clinical diagnostic tool for Tuberculosis diagnosis among HIV infected children is limited, calling for further validation. HIV infected children with lymphadenopathy, failure to thrive and difficulty in breathing are at high risk of Tuberculosis.
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Affiliation(s)
- Sauda A Mutabazi
- Department of Paediatrics & Child Health, University of Dodoma Tanzania
| | - Shakilu Jumanne
- Department of Paediatrics & Child Health, University of Dodoma Tanzania.
| | - Bonaventura Ct Mpondo
- Ministry of Health Community Development, Gender, Elderly and Children, National AIDS Control Program, Dodoma, Tanzania
| | - David P Mnzava
- Ministry of Health Community Development, Gender, Elderly and Children, Tanganyika Medical Council, Dodoma, Tanzania
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6
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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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7
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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: 23] [Impact Index Per Article: 4.6] [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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8
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Marcy O, Tejiokem M, Msellati P, Truong Huu K, Do Chau V, Tran Ngoc D, Nacro B, Ateba-Ndongo F, Tetang-Ndiang S, Ung V, Dim B, Neou L, Berteloot L, Borand L, Delacourt C, Blanche S. Mortality and its determinants in antiretroviral treatment-naive HIV-infected children with suspected tuberculosis: an observational cohort study. Lancet HIV 2017; 5:e87-e95. [PMID: 29174612 DOI: 10.1016/s2352-3018(17)30206-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/01/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tuberculosis is a major cause of morbidity and mortality in HIV-infected children, but is difficult to diagnose. We studied mortality and its determinants in antiretroviral treatment (ART)-naive HIV-infected children presenting with suspected tuberculosis. METHODS In this observational cohort study, HIV-infected children aged 13 years or younger with suspected tuberculosis were followed up for 6 months as part of the ANRS 12229 PAANTHER 01 cohort in eight hospitals in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam). Children started ART and antituberculosis treatment at the clinician's discretion and were retrospectively classified into one of three groups by tuberculosis documentation: confirmed by culture or Xpert MTB/RIF, unconfirmed, and unlikely. We assessed mortality and associated factors using Kaplan-Meier methods and Cox proportional hazard models. The ANRS 12229 PAANTHER 01 study is registered at ClinicalTrials.gov, number NCT01331811. FINDINGS 266 (61%) of 438 children enrolled in the study between April 27, 2011, and May 31, 2014, were ART-naive and included in the analysis (40 had confirmed tuberculosis, 119 unconfirmed tuberculosis, and 107 unlikely tuberculosis). 112·5 person-years of follow-up were available. 154 children (58%) started antituberculosis treatment and 212 (80%) started ART. 50 children (19%) died. Mortality by 6 months was higher in children with confirmed tuberculosis (14 deaths; 2 month survival probability 65·0% [95% CI 50·2-79·8]) compared with unconfirmed tuberculosis (19 deaths; 83·5% [76·8-90·3]) and unlikely tuberculosis (17 deaths; 83·5% [76·3-90·7]; log-rank p=0·0141) and was lower in children with confirmed or unconfirmed tuberculosis who started antituberculosis treatment (p<0·0001 for both). In a multivariate analysis, ART started during the first month of follow-up (hazard ratio 0·08; 95% CI 0·01-0·67), confirmed tuberculosis (6·33; 2·15-18·64), young age (5·90; 2·02-17·19), CD4 less than 10% (2·63; 1·25-5·53), miliary features (4·08; 1·56-10·66), and elevated serum transaminases (4·40; 1·82-10·65) were all independently associated with mortality. INTERPRETATION In our cohort, mortality was high in the first 6 months after suspicion of tuberculosis in ART-naive children. ART should be started early, particularly in children with factors associated with high mortality. Documented or empirical tuberculosis treatment decision should be accelerated to reduce mortality and allow early ART initiation. FUNDING ANRS and Fondation Total.
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Affiliation(s)
- Olivier Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Bordeaux Population Health Centre U1219, Université de Bordeaux, Bordeaux, France.
| | - Mathurin Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | - Philippe Msellati
- UMI 233-U1175 TransVIHMI, Institut de Recherche pour le Développement, Université de Montpellier, Montpellier, France
| | - Khanh Truong Huu
- Infectious Disease Department, Pediatric Hospital Nhi Dong 1, Ho Chi Minh City, Vietnam
| | - Viet Do Chau
- Infectious Disease Department, Pediatric Hospital Nhi Dong 2, Ho Chi Minh City, Vietnam
| | - Duong Tran Ngoc
- Pediatric Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Boubacar Nacro
- Service de Pédiatrie, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso
| | | | | | - Vibol Ung
- Tuberculosis/HIV Department, National Pediatric Hospital, Phnom Penh, Cambodia; Planning and Research Department, University of Health Sciences, Phnom Penh, Cambodia
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Leakhena Neou
- Neonatal Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Laureline Berteloot
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Stéphane Blanche
- Unité d'Immunologie Hématologie Rhumatologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France
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9
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Li RL, Wang JL, Wang XF, Wang MS. Tuberculosis in infants: a retrospective study in China. SPRINGERPLUS 2016; 5:546. [PMID: 27186509 PMCID: PMC4848284 DOI: 10.1186/s40064-016-2184-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/19/2016] [Indexed: 01/05/2023]
Abstract
To describe the demographics, clinical characteristics and microbiologic findings of infant (≤2 years old) tuberculosis (TB) in a high TB burden country. Between Feb, 2007 and Jun, 2015, 115 TB infants who admitted to our hospital were enrolled in the study. Their clinicopathological characteristics were reviewed and analyzed. The mean age was 10.1 ± 7.4 (SD) months, and 84 of 115 infants (73.0 %) were males. 23 patients (20.0 %) had isolated pulmonary TB, 18 patients (15.7 %) had pulmonary and extrapulmonary TB (EPTB), the remaining 74 patients (64.4 %) had exclusively EPTB. The most common site of EPTB was lymph node (n = 61), 54 cases were left axillary lymph node involvement. 49 of 51 patients (96.1 %) were validated by pathological examination, 5 of 57 patients (8.8 %) were positive on acid fast bacilli smear, and 27 of 103 patients (26.2 %) were confirmed by mycobacterial culture. 29 of 59 patients (49.2 %) were PPD positive, 14 of 30 patients (46.7 %) were T-SPOT.TB positive. The most common complaints of patients were lymph node swelling (53.0 %), fever (36.5 %), cough (28.7 %) and dyspnea (10.4 %). There was significant difference in the time before hospital admission among different types of tuberculosis (P < 0.01), fever was also a factor influencing the time (P < 0.05). In infants, the sensitivities of routine TB tests were low and emphasize the need for improved diagnostics; EPTB was more common than pulmonary TB, tuberculous lymphadenitis constituted a high proportion of EPTB; there appears to be an association between the incidence of axillary lymph node TB and BCG vaccination among infants in China.
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Affiliation(s)
- Ruo-Lin Li
- Department of Medicine Research, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi People's Republic of China
| | - Jun-Li Wang
- Center of Clinical Laboratory, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, Guangxi People's Republic of China
| | - Xin-Feng Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013 People's Republic of China
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, 46# Lishan Road, Jinan City, 250013 People's Republic of China
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10
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Graham SM, Cuevas LE, Jean-Philippe P, Browning R, Casenghi M, Detjen AK, Gnanashanmugam D, Hesseling AC, Kampmann B, Mandalakas A, Marais BJ, Schito M, Spiegel HML, Starke JR, Worrell C, Zar HJ. Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update. Clin Infect Dis 2015; 61Suppl 3:S179-87. [PMID: 26409281 PMCID: PMC4583568 DOI: 10.1093/cid/civ581] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Consensus case definitions for childhood tuberculosis have been proposed by an international expert panel, aiming to standardize the reporting of cases in research focusing on the diagnosis of intrathoracic tuberculosis in children. These definitions are intended for tuberculosis diagnostic evaluation studies of symptomatic children with clinical suspicion of intrathoracic tuberculosis, and were not intended to predefine inclusion criteria into such studies. Feedback from researchers suggested that further clarification was required and that these case definitions could be further improved. Particular concerns were the perceived complexity and overlap of some case definitions, as well as the potential exclusion of children with acute onset of symptoms or less severe disease. The updated case definitions proposed here incorporate a number of key changes that aim to reduce complexity and improve research performance, while maintaining the original focus on symptomatic children suspected of having intrathoracic tuberculosis. The changes proposed should enhance harmonized classification for intrathoracic tuberculosis disease in children across studies, resulting in greater comparability and the much-needed ability to pool study results.
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Affiliation(s)
- Stephen M. Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Burnet Institute, Melbourne, Australia
| | - Luis E. Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom
| | | | - Renee Browning
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | | | - Anne K. Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Devasena Gnanashanmugam
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Anneke C. Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Beate Kampmann
- Department of Paediatrics, Imperial College London, United Kingdom
- Vaccinology Theme, MRC Unit, The Gambia
| | - Anna Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Ben J. Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity) and the Sydney Emerging Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Australia
| | | | | | - Jeffrey R. Starke
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Carol Worrell
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa
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