1
|
Loesch RBR, Ribeiro RM, Conceição C. Tuberculosis contact investigation in African Portuguese-speaking countries at End TB Strategy era: a scoping review. BMJ Open 2022; 12:e056761. [PMID: 35379632 PMCID: PMC8981322 DOI: 10.1136/bmjopen-2021-056761] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The contact investigation of tuberculosis (TB) index case is one of the critical elements pointed by the WHO to reach the end of the TB epidemic. The scoping review aimed to map out the recommended and the adopted processes applied to active contact investigation of TB index case in African Portuguese-speaking countries (PALOP). DESIGN Scoping review. DATA SOURCES We searched B-on, Cochrane Library, PubMed, Web of Science, Scopus, WHOLIS, IRIS, OKR, each country's Ministry of Health websites, WHO, Global Fund, World Bank and bibliographic reference lists from February to May 2020. ELIGIBILITY CRITERIA All available literature on TB contact investigation in each country part of PALOP (Angola, Cape Verde, Guinea-Bissau, Mozambique and Sao Tome and Principe) published from 1 January 2010 to 31 January2020. DATA EXTRACTION AND SYNTHESIS A data-charting form was developed to extract data on documents' characteristics and variables pertinent to the TB contact investigation process. Before qualitative analysis, we thematically synthesised findings and converted them into appropriate text units. RESULTS Fifteen documents were included in the scoping review. The recommended processes for TB contact investigation were identified only for Cape Verde and Mozambique. It included clinical evaluation, counselling and testing for HIV, chest radiography, tuberculin skin test, sputum smear microscopy or Xpert MTB/RIF. The adopted processes were detected only in research studies from Angola, Guinea-Bissau and Mozambique. Therefore, they cannot be assumed as adopted within the scope of the national programmes of the respective countries. CONCLUSION This review highlights the scarcity of references on TB contact investigation in PALOP at the End TB Strategy era. Furthermore, it is well clear the importance of an information system that provides actual data for assessing the real impact of such interventions in controlling the disease in African Portuguese-speaking countries.
Collapse
Affiliation(s)
| | - Rafaela M Ribeiro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Cláudia Conceição
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| |
Collapse
|
2
|
Imsanguan W, Bupachat S, Wanchaithanawong V, Luangjina S, Thawtheong S, Nedsuwan S, Pungrassami P, Mahasirimongkol S, Wiriyaprasobchok A, Kaewmamuang K, Kamolwat P, Ngamvithayapong-Yanai J. Contact tracing for tuberculosis, Thailand. Bull World Health Organ 2020; 98:212-218. [PMID: 32132756 PMCID: PMC7047024 DOI: 10.2471/blt.19.239293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/22/2019] [Accepted: 01/03/2020] [Indexed: 12/03/2022] Open
Abstract
Problem Despite implementation of universal health coverage in Thailand, gaps remain in the system for screening contacts of tuberculosis patients. Approach We designed broader criteria for contact investigation and new screening practices and assessed the approach in a programme-based operational research study in 2017–2018. Clinic staff interviewed 100 index patients and asked them to give household and non-household contacts an invitation for a free screening and chest X-ray. Contact persons who attended received 250 Thai baht (about 8 United States dollars) allowance for transport. Local setting Chiang Rai province, Thailand, has high rates of tuberculosis notification and a high number of people living in poverty. The coverage of contact investigation in under 5-year-olds was only 33.2% (222 screened out of 668 contacts) over 2011–2015. Relevant changes Index patients identified 440 contacts in total and gave invitation cards to 227 of them. The contact investigation coverage was 81.1% (184/227) and tuberculosis detection among contacts screened was 6.0% (11/184). Of the 11 contacts with active tuberculosis, three did not have tuberculosis symptoms, three were non-household contacts and three were contacts of non-smear-positive tuberculosis patients. The contact investigation coverage of the contacts younger than 5 years was 100% (14/14) and the yield of tuberculosis detection in this age group was 21.4% (3/14). Lessons learnt High coverage of contact investigation with a high yield of tuberculosis detection among contacts can be achieved by applying broader criteria for contact investigation and providing financial support for transportation.
Collapse
Affiliation(s)
| | - Surasit Bupachat
- TB/HIV Research Foundation, 1050/1 Satarnpayabarn Rd., Muang District, Chiang Rai 57000, Thailand
| | | | - Sarmwai Luangjina
- TB/HIV Research Foundation, 1050/1 Satarnpayabarn Rd., Muang District, Chiang Rai 57000, Thailand
| | - Sureerat Thawtheong
- TB/HIV Research Foundation, 1050/1 Satarnpayabarn Rd., Muang District, Chiang Rai 57000, Thailand
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Debulpaep S, Dreesman A, Dirix V, Toppet V, Wanlin M, Geysens L, Arrazola de Oñate W, Fauville M, Mascart F, Levy J, Mouchet F. Tuberculosis Transmission in a Primary School and a Private Language School. An Estimation of Infectivity. Front Pediatr 2020; 8:10. [PMID: 32117825 PMCID: PMC7018764 DOI: 10.3389/fped.2020.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Belgium is a country with low incidence of tuberculosis (TB) and a very low number of TB cases in children. Children in contact with an adult smear-positive TB case are at high risk of transmission. Early diagnosis is important as young children have a significant predisposition of developing TB disease. In this paper, we describe two outbreaks after exposure to, respectively, two teachers with smear-positive pulmonary TB: one in a primary school, a nursery teacher, and another in a private language school. Methods: An exposure investigation was carried out in both index cases household and school, according to the stone-in-the-pond principle. The tuberculin skin test (TST) was used a screening tool. The time elapsed between TB diagnosis in the index case and contact investigation was, respectively, 1 and 3 weeks. If this initial test was negative, it was repeated after a "window period" of ≥8 weeks. Results: Index cases showed a transmission rate of, respectively, 13 and 40% in their classes at school, defined as casual contacts. The proximity of contact increased the risk of infection. TB disease was observed in, respectively, 4 and 11% of all the casual contacts; all of them were children younger than 5 years old. TB-infected and children with active TB disease had good compliance with recommended treatment. Uptake of chemoprophylaxis during the "window period" was poor, respectively, only 32-42%, in children under 5 years with an initially negative TST. Discussion: The World Health Organization recommends to screen all young children (<5 years old) who have close contact with a person affected by pulmonary TB and to initiate Latent tuberculosis infection treatment even before infection can be demonstrated, after ruling out active TB disease. Despite this knowledge, a small percentage of the children younger than 5 years with no proof of infection was treated with the proposed chemoprophylactic treatment, in both cases. Conclusion: This exposure investigation of two teachers detects high transmission among family contacts and school casual contacts. Recommendations for chemoprophylactic treatment in children <5 years showed low compliance, reflecting the difficulty of communication to staff, parents, and children in a school outbreak. It is essential to develop a new approach for this vulnerable group of patients. This approach could be improved, applied, and evaluated by National TB Control Programs, involving public and private health services. Public health authorities play a role in raising public awareness about the risks of TB for young children.
Collapse
Affiliation(s)
- Sara Debulpaep
- Pediatric Department, CHU Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium.,Pediatric Department, Ghent University Hospital, Ghent, Belgium
| | - Alexandra Dreesman
- Pediatric Department, CHU Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Violette Dirix
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Toppet
- Department of Pediatric Radiology, CHU Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maryse Wanlin
- French Association for Respiratory Health and Tuberculosis Control FARES, Brussels, Belgium
| | - Lies Geysens
- Flemish Association for Respiratory Health and Tuberculosis Control VRGT, Brussels, Belgium
| | | | - Maryse Fauville
- The Belgian Scientific Institute for Public Health (Sciensano), Brussels, Belgium
| | - Françoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium.,Immunobiology Clinic, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jack Levy
- Pediatric Department, CHU Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Mouchet
- Pediatric Department, CHU Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
4
|
Ben Ayed H, Gargouri L, Koubaa M, Rekik K, Hammemi F, Ben Jemaa M, Ben Hmida M, Mahfoudh A, Damak J, Ben Jemaa M. The growing burden of childhood tuberculosis in Southern Tunisia: temporal trends across two decades: 1995-2016. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/109660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
5
|
Ngamvithayapong-Yanai J, Luangjina S, Thawthong S, Bupachat S, Imsangaun W. Stigma against tuberculosis may hinder non-household contact investigation: a qualitative study in Thailand. Public Health Action 2019; 9:15-23. [PMID: 30963038 DOI: 10.5588/pha.18.0055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/09/2018] [Indexed: 11/10/2022] Open
Abstract
Setting A northern province in Thailand. Objectives To explore experiences and perspectives on tuberculosis (TB) contact investigations in non-household contacts. Design Focus group discussions and in-depth interviews with eight groups: three groups of former TB patients (teachers, students and hospital staff) and five groups of representatives from congregate settings such as schools and workplaces. Data were analysed using the modified grounded theory. Result Annual health check-ups at the workplace contributed to the early detection of active TB in teachers. Former TB patients were highly exposed to non-household contacts, but contact investigations were limited to household contacts only. Barriers and facilitators for non-household contact investigations are associated with five factors, including information, awareness and knowledge about TB; stigma; empathy; health system response and informing non-household contacts about TB exposure. Stigma may be the main barrier to investigations among non-household contacts because TB patients tend to withhold information about their diagnosis from colleagues. Lack of knowledge and misperceptions regarding TB transmission contributed to stigma. Empathy with other people encouraged TB patients to inform non-household contacts. Conclusion Non-household contact investigations are not performed despite the risk of TB transmission. To promote contact investigations in congregate settings, interventions to overcome TB stigma and improve public knowledge about TB transmission are required.
Collapse
Affiliation(s)
| | - S Luangjina
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - S Thawthong
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - S Bupachat
- TB/HIV Research Foundation, Chiang Rai, Thailand
| | - W Imsangaun
- Department of Internal Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| |
Collapse
|
6
|
School and household tuberculosis contact investigations in Swaziland: Active TB case finding in a high HIV/TB burden setting. PLoS One 2017; 12:e0178873. [PMID: 28582435 PMCID: PMC5459449 DOI: 10.1371/journal.pone.0178873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Investigation of household contacts exposed to infectious tuberculosis (TB) is widely recommended by international guidelines to identify secondary cases of TB and limit spread. There is little data to guide the use of contact investigations outside of the household, despite strong evidence that most TB infections occur outside of the home in TB high burden settings. In older adolescents, the majority of infections are estimated to occur in school. Therefore, as part of a project to increase active case finding in Swaziland, we performed school contact investigations following the identification of a student with infectious TB. Methods The Butimba Project identified 7 adolescent TB index cases (age 10–20) with microbiologically confirmed disease attending 6 different schools between June 2014 and March 2015. In addition to household contact investigations, Butimba Project staff worked with the Swaziland School Health Programme (SHP) to perform school contact investigations. At 6 school TB screening events, between May and October 2015, selected students underwent voluntary TB screening and those with positive symptom screens provided sputum for TB testing. Results Among 2015 student contacts tested, 177 (9%) screened positive for TB symptoms, 132 (75%) produced a sputum sample, of which zero tested positive for TB. Household contact investigations of the same index cases yielded 40 contacts; 24 (60%) screened positive for symptoms; 19 produced a sputum sample, of which one case was confirmed positive for TB. The odds ratio of developing TB following household vs. school contact exposure was significantly lower (OR 0.0, 95% CI 0.0 to 0.18, P = 0.02) after exposure in school. Conclusion School-based contact investigations require further research to establish best practices in TB high burden settings. In this case, a symptom-based screening approach did not identify additional cases of tuberculosis. In comparison, household contact investigations yielded a higher percentage of contacts with positive TB screens and an additional tuberculosis case.
Collapse
|
7
|
Bruno B, Busca A, Vallero S, Raviolo S, Mordini N, Nassi L, Cignetti A, Audisio E, Festuccia M, Corsetti A, Depaoli L, Faraci M, Micalizzi C, Corcione S, Berger M, Saglio F, Caropreso P, Mengozzi G, Squadrone V, De Rosa FG, Giaccone L. Current use and potential role of procalcitonin in the diagnostic work up and follow up of febrile neutropenia in hematological patients. Expert Rev Hematol 2017; 10:543-550. [PMID: 28471695 DOI: 10.1080/17474086.2017.1326813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. Its etiology is most often due to infections even though FN of other origins, such as tumor-related fever and non-infectious inflammation, should rapidly be ruled out. Initially, C-reactive protein and, more recently, procalcitonin (PCT) have been proposed as useful biomarkers for differential diagnosis. PCT was shown to be a good biomarker of bacterial infections and their clinical outcomes. Definition of standard cut-offs and design of PCT-guided treatment protocols remain however to be defined. Areas covered: In this review, highlights on the current clinical use of PCT and its potential role as a diagnostic tool have been discussed by a panel of physicians from different areas of expertise. We provide current clinical evidence that PCT has been shown to be a reliable biomarker to differentiate fever of bacterial origin from other causes. Moreover, the Authors convened to a round-table to discuss their 'real-life experience' and offer their recommendations by a Delphi survey. Expert commentary: PCT has an important clinical role in FN. Issues such as the validation of a specific decision algorithm that includes PCT to monitor antibiotic choice and treatment duration will be addressed in prospective studies.
Collapse
Affiliation(s)
- Benedetto Bruno
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Alessandro Busca
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Stefano Vallero
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Stefania Raviolo
- d Department of Clinical Sciences , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Nicola Mordini
- e Hematology , S, Croce e Carle Hospital , Cuneo , Italy
| | - Luca Nassi
- f Hematology , AOU Maggiore della Carità and University of Eastern Piedmont , Novara , Italy
| | | | - Ernesta Audisio
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Moreno Festuccia
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | | | - Lorella Depaoli
- h Hematology , SS Antonio e Biagio Hospital , Alessandria , Italy
| | - Maura Faraci
- i Department of Hematology-Oncology , Istituto G. Gaslini , Genova , Italy
| | - Concetta Micalizzi
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Silvia Corcione
- d Department of Clinical Sciences , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Massimo Berger
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Francesco Saglio
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Paola Caropreso
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Giulio Mengozzi
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Vincenzo Squadrone
- k Department of Intensive Care and Critical Care , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | | | - Luisa Giaccone
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| |
Collapse
|
8
|
Abstract
This study is the largest report on Mycobacterium tuberculosis transmission rate (TR) from children with pulmonary tuberculosis to school pupils. Higher TR (around 21.6%) was observed in contacts of smear-positive children. TR from pediatric smear-negative index cases was around 0. If our data are confirmed, school contacts of a smear-negative index case could be screened only by clinical evaluation and tuberculin skin test, avoiding the routine use of chest radiographs in children less than 5 years of age as well.
Collapse
|
9
|
Contact Investigations Around Mycobacterium tuberculosis Patients Without Positive Respiratory Culture. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 22:275-82. [PMID: 25867495 DOI: 10.1097/phh.0000000000000261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the yield and effectiveness of contact investigations conducted around potentially infectious tuberculosis (TB) patients with no positive respiratory culture for Mycobacterium tuberculosis in New York City (NYC). DESIGN All TB patients without a positive respiratory culture from 2003 to 2012 were extracted from the NYC TB registry, and all patients eligible for contact investigation and their contacts were evaluated. Patients without a positive respiratory culture were defined as eligible for contact investigation if they had a respiratory nucleic acid amplification result positive for M tuberculosis, a cavitary chest radiograph, or a positive respiratory acid-fast bacilli smear. SETTING NYC, New York. MAIN OUTCOME MEASURES To evaluate the yield of the investigations, the number of contacts identified and the outcome of testing was quantified. Potential transmission was defined on the basis of whether active TB patients were detected among the contacts and if a contact had a TB test conversion. RESULTS From 2003 to 2012, there were 2191 TB patients without a positive respiratory culture in NYC, 374 (17%) of which were considered eligible for contact investigation. A total of 11 096 contacts were identified around 300 (80%) eligible patients, 136 of whom had a diagnosis of TB infection; of those with TB infection who initiated preventive treatment, 66% completed treatment. Potential transmission was identified around 14 patients, with the identification of 2 additional cases of active TB and 15 contacts with TB infection test conversion. CONCLUSIONS Conducting contact investigations around patients without a positive respiratory culture yielded evidence of possible transmission and led to the identification and treatment of new TB cases and those with TB infection. These findings suggest that these investigations should be conducted in settings where resources permit.
Collapse
|
10
|
Schepisi MS, Sotgiu G, Contini S, Puro V, Ippolito G, Girardi E. Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis. PLoS One 2015; 10:e0121639. [PMID: 25835507 PMCID: PMC4383623 DOI: 10.1371/journal.pone.0121639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/11/2015] [Indexed: 11/18/2022] Open
Abstract
Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04-0.21) for infants, 0.38% (95% CI 0.01-1.60) for children, 0.09% (95% CI 0.02-0.22) for adults and 0.00% (95% CI 0.00-0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 - 2.02) for infants, 0.9% (95% CI 0.40-1.60) for children, 4.32% (95% CI 1.43-8.67) for adults and 2.62% (95% CI 1.05-4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.
Collapse
Affiliation(s)
- Monica Sañé Schepisi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
- * E-mail:
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Silvia Contini
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Vincenzo Puro
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Enrico Girardi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| |
Collapse
|
11
|
De D, Kinikar A, Adhav PS, Kamble S, Sahoo P, Koli H, Kanade S, Mave V, Suryavanshi N, Gupte N, Gupta A, Mathad J. Source Case Investigation for Children with TB Disease in Pune, India. Tuberc Res Treat 2014; 2014:182836. [PMID: 25243086 PMCID: PMC4163291 DOI: 10.1155/2014/182836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022] Open
Abstract
Setting. Contact tracing is broadly encouraged for tuberculosis (TB) control. In many high-burden countries, however, little effort is made to identify contacts of newly diagnosed TB patients. This failure puts children, many of whom live in poor crowded communities, at special risk. Objectives. To perform source-case investigations for 50 pediatric TB cases in Pune, India. Design. A descriptive cross-sectional observational study of pediatric TB cases < 5 years of age. Information was collected about the index case and household contacts. Results. In 15 (30%) of the 50 pediatric index cases, the household contained known TB contacts, 14 (86%) of whom were adults. Prior to their own diagnosis of TB, only one of the 15 pediatric index cases who met criteria for isoniazid preventive therapy received it. The index cases with known household TB contacts had a longer delay in initiating TB treatment than those without TB contacts (17.5 versus 2 days; P = 0.03). Use of contact tracing identified 14 additional household TB suspects, 8 (57%) of whom were children. Conclusions. This study identified missed opportunities for TB prevention, as contact tracing is poorly implemented in resource-limited countries, like India. Further strategies to improve the implementation of TB prevention, especially in young children, are urgently needed.
Collapse
Affiliation(s)
- Debalina De
- University of Michigan Medical School, 1301 Catherine Road, Ann Arbor, MI 48109, USA
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Medical College/Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - P. S. Adhav
- Byramjee Jeejeebhoy Medical College/Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Sunanda Kamble
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Prasanna Sahoo
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Hari Koli
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Savita Kanade
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Medical College/Johns Hopkins Clinical Trials Unit, Jai Prakash Narayan Road, Pune, Maharashtra 411001, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Jyoti Mathad
- Division of Infectious Diseases, Weill Cornell Medical College, 525 E 68th Street, New York, NY 10021, USA
| |
Collapse
|
12
|
Thomas TA, Heysell SK, Moodley P, Montreuil R, Ha X, Friedland G, Bamber SA, Moll AP, Gandhi N, Brant WE, Sturm W, Shah S. Intensified specimen collection to improve tuberculosis diagnosis in children from Rural South Africa, an observational study. BMC Infect Dis 2014; 14:11. [PMID: 24400822 PMCID: PMC3890632 DOI: 10.1186/1471-2334-14-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/06/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In drug-resistant TB settings, specimen collection is critical for drug-susceptibility testing (DST). This observational study included multiple specimen types collected from pediatric TB suspects with the aim to determine diagnostic yield and inform clinical practice in children with drug-resistant and drug-susceptible TB. METHODS From 03/2009-07/2010, TB suspects aged ≥6 months and ≤12 years were recruited among outpatient and inpatient settings. Subjects were new TB suspects or had persistent symptoms despite ≥2 months of TB treatment. The protocol included collection of a single blood and urine specimen, a single sputum induction and, if inpatients and <5 years of age, collection of 3 gastric aspirates (GA). Samples were cultured on solid and/or liquid media. DST was by 1% proportion method. RESULTS Among 118 children with possible, probable or confirmed TB, the mean age was 4.9 years [SD 3.2] and 64 (62%) of those tested were HIV-positive. Eight (7%) subjects were culture-positive from at least one specimen; yield did not differ by HIV status or TB treatment history. Among those with positive cultures, 7/8 (88%) were from induced sputum, 5/6 (83%) from GA, 3/8 (38%) from blood, and 3/7 (43%) from urine. In subjects with both induced sputum and GA collection, sputum provided one additional case compared to GA. Multidrug resistant (MDR)-TB was detected by urine culture alone in one child >5 years old. Pan-resistant extensively drug resistant (XDR)-TB was identified by cultures from all sites in one subject. CONCLUSIONS TB was cultured from HIV-positive and -negative children, and allowed for identification of MDR and XDR-TB cases. Urine and induced sputum each provided an additional TB diagnosis and, when compared to GA, may be considered a less invasive, same-day method of specimen collection for childhood TB suspects. This study illustrates the continued challenges and limitations of available strategies for pediatric TB diagnostics.
Collapse
Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases & International Health, University of Virginia, PO Box 801337, Charlottesville, VA 22908-1337, USA
| | - Scott K Heysell
- Division of Infectious Diseases & International Health, University of Virginia, PO Box 801337, Charlottesville, VA 22908-1337, USA
| | | | - Romualde Montreuil
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xia Ha
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Neel Gandhi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - William E Brant
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Willem Sturm
- University of KwaZulu-Natal, Durban, KZN, South Africa
| | - Sarita Shah
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
13
|
Abstract
The ongoing spread of tuberculosis (TB) in poor resource countries and the recently increasing incidence in high resource countries lead to the need of updated knowledge for clinicians, particularly for pediatricians. The purpose of this article is to provide an overview on the most important peculiarities of TB in children. Children are less contagious than adults, but the risk of progression to active disease is higher in infants and children as compared to the subsequent ages. Diagnosis of TB in children is more difficult than in adults, because few signs are associated with primary infection, interferon-gamma release assays and tuberculin skin test are less reliable in younger children, M. tuberculosis is more rarely detected in gastric aspirates than in smears in adults and radiological findings are often not specific. Treatment of latent TB is always necessary in young children, whereas it is recommended in older children, as well as in adults, only in particular conditions. Antimycobacterial drugs are generally better tolerated in children as compared to adults, but off-label use of second-line antimycobacterial drugs is increasing, because of spreading of multidrug resistant TB worldwide. Given that TB is a disease which often involves more than one member in a family, a closer collaboration is needed between pediatricians and clinicians who take care of adults.
Collapse
Affiliation(s)
- Paola Piccini
- Emerging Bacterial Pathogens Unit; San Raffaele Scientific Institute, Milan, Italy
| | - Elena Chiappini
- Emerging Bacterial Pathogens Unit; San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit; San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
| |
Collapse
|