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Akalu TY, Clements ACA, Gebreyohannes EA, Gilmour B, Alene KA. Prevalence of tuberculosis infection among contacts of drug-resistant tuberculosis patients: A systematic review and meta-analysis. J Infect 2024; 89:106198. [PMID: 38906264 DOI: 10.1016/j.jinf.2024.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Contact investigations with drug-susceptible tuberculosis (DS-TB) patients have demonstrated a high prevalence of tuberculosis infection (TBI). However, the prevalence of TBI among individuals in close contact with drug-resistant tuberculosis (DR-TB) patients is poorly understood. This systematic review and meta-analysis aimed to determine the prevalence of TBI among household and non-household contacts of DR-TB patients. METHOD AND ANALYSIS We searched five databases (Medline, Embase, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) from inception to 2 June 2023. All studies that reported the prevalence of TBI among DR-TB contacts were included in the study. A random-effects meta-analysis was conducted to estimate the pooled prevalence of TBI with a 95% confidence interval (CI). Sub-group analyses were conducted using study characteristics as covariates. RESULTS Thirty studies involving 7659 study participants from 19 countries were included. The pooled prevalence of TBI among DR-TB contacts was 36.52% (95% CI: 30.27-42.77). The sub-group analysis showed considerable heterogeneity in the estimates, with the highest prevalence reported in Southeast Asia (80.74%; 95% CI: 74.09-87.39), household contacts (38.60%; 95% CI: 30.07-47.14), lower-middle-income countries (LMICs) (54.72; 95% CI: 35.90, 73.55), children (43.27%; 95% CI: 25.50, 61.04), and studies conducted between 2004 and 2012 (45.10; 95% CI: 32.44, 57.76). CONCLUSION The prevalence of TBI among DR-TB contacts was high, with substantial regional variations. Further research is needed to determine the drug susceptibility status of TBI in DR-TB contacts. PROTOCOL REGISTRATION The protocol is registered in PROSPERO (CRD42023390339).
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Affiliation(s)
- Temesgen Yihunie Akalu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Australia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Australia; Research and Enterprise, Queen's University Belfast, Belfast, United Kingdom
| | - Eyob Alemayehu Gebreyohannes
- School of Allied Health, University of Western Australia, Perth, WA, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Beth Gilmour
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Australia
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Australia
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2
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Weng S, Ma H, Lin T, He Y, Zhang J, Zhang X, Wang H, Zhang W, Xu Y. Mycobacterium tuberculosis Mce2D protein blocks M1 polarization in macrophages by inhibiting the ERK signaling pathway. Microb Pathog 2023; 184:106367. [PMID: 37778704 DOI: 10.1016/j.micpath.2023.106367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Macrophages play a pivotal role in controlling Mycobacterium infection, and the pathogen thrives in the event of immune evasion and immunosuppression of macrophages. Mammalian cell entry proteins (Mce) are required for Mycobacterium tuberculosis (M. tb) growth and the host cell's initial phagocytosis and cytokine response. Mce2D protein is one of a family of proteins that infect M. tb; however, the function and mechanism of action remain unclear. In this study, we constructed the Mce2D knockout strain using Mycobacterium smegmatis to study the function of Mce2D in the infection of macrophages. The results indicated that compared to the knockout strain, the release of proinflammatory cytokines (TNF-α and IL-1β) reduced when WT strain infected the macrophages. Moreover, Mce2D boosted the metabolism of oxidized fatty acids, increased the energy supply of TCA, and lowered the glycolysis of glucose in macrophages after bacterial infection, all of which prevented the polarization of macrophages to M1, which was driven by the fact that Mce2D blocked ERK2 phosphorylation by interacting with ERK2 through its DEF motif. This, in turn, promoted nuclear translocation of HIF-1α, allowing signal accumulation, which increased the HIF-1α transcription levels. Finally, the mouse infection experiment showed that Mce2D caused blockage of M1 polarization of alveolar macrophages, resulting in reduced bactericidal activity and antigen presentation, weakening Th1 cell-mediated immune response and helping bacteria escape the immune system. Our results reveal that Mce2D causes immune escape by blocking M1 polarization in macrophages, providing potential targets for the rational design of therapies against M. tb infection.
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Affiliation(s)
- Shufeng Weng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Huixia Ma
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Taiyue Lin
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yumo He
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinyi Zhang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuelian Zhang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Honghai Wang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhong Zhang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Huashen Institute of Microbes and Infections, Shanghai, China
| | - Ying Xu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Huashen Institute of Microbes and Infections, Shanghai, China.
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3
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Bachanová P, Cheyne A, Broderick C, Newton SM, Levin M, Kaforou M. Comparative transcriptomic analysis of whole blood mycobacterial growth assays and tuberculosis patients' blood RNA profiles. Sci Rep 2022; 12:17684. [PMID: 36271270 PMCID: PMC9587058 DOI: 10.1038/s41598-022-20409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
In vitro whole blood infection models are used for elucidating the immune response to Mycobacterium tuberculosis (Mtb). They exhibit commonalities but also differences, to the in vivo blood transcriptional response during natural human Mtb disease. Here, we present a description of concordant and discordant components of the immune response in blood, quantified through transcriptional profiling in an in vitro whole blood infection model compared to whole blood from patients with tuberculosis disease. We identified concordantly and discordantly expressed gene modules and performed in silico cell deconvolution. A high degree of concordance of gene expression between both adult and paediatric in vivo-in vitro tuberculosis infection was identified. Concordance in paediatric in vivo vs in vitro comparison is largely characterised by immune suppression, while in adults the comparison is marked by concordant immune activation, particularly that of inflammation, chemokine, and interferon signalling. Discordance between in vitro and in vivo increases over time and is driven by T-cell regulation and monocyte-related gene expression, likely due to apoptotic depletion of monocytes and increasing relative fraction of longer-lived cell types, such as T and B cells. Our approach facilitates a more informed use of the whole blood in vitro model, while also accounting for its limitations.
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Affiliation(s)
- Petra Bachanová
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ashleigh Cheyne
- Department of Infectious Disease, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology and Infection, Department of Life Sciences, Imperial College London, London, UK
| | - Claire Broderick
- Department of Infectious Disease, Imperial College London, London, UK
| | - Sandra M Newton
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, UK.
- Centre for Paediatrics and Child Health, Imperial College London, London, UK.
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4
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Nordholm AC, Lillebaek T. It is time to optimise the management of latent tuberculosis infection in children. Eur Respir J 2021; 57:57/4/2004438. [PMID: 33888534 DOI: 10.1183/13993003.04438-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Anne Christine Nordholm
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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5
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Sudbury EL, Clifford V, Messina NL, Song R, Curtis N. Mycobacterium tuberculosis-specific cytokine biomarkers to differentiate active TB and LTBI: A systematic review. J Infect 2020; 81:873-881. [PMID: 33007340 DOI: 10.1016/j.jinf.2020.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/21/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES New tests are needed to overcome the limitations of existing immunodiagnostic tests for tuberculosis (TB) infection, including their inability to differentiate between active TB and latent TB infection (LTBI). This review aimed to identify the most promising cytokine biomarkers for use as stage-specific markers of TB infection. METHODS A systematic review was done using electronic databases to identify studies that have investigated Mycobacterium tuberculosis (MTB)-specific cytokine responses as diagnostic tools to differentiate between LTBI and active TB. RESULTS The 56 studies included in this systematic review measured the MTB-specific responses of 100 cytokines, the most frequently studied of which were IFN-γ, IL-2, TNF-α, IP-10, IL-10 and IL-13. Ten studies assessed combinations of cytokines, most commonly IL-2 and IFN-γ. For most cytokines, findings were heterogenous between studies. The variation in results likely relates to differences in the study design and laboratory methods, as well as participant and environmental factors. CONCLUSIONS Although several cytokines show promise as stage-specific markers of TB infection, this review highlights the need for further well-designed studies, in both adult and paediatric populations, to establish which cytokine(s) will be of most use in a new generation of immunodiagnostic tests.
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Affiliation(s)
- Eva L Sudbury
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
| | - Vanessa Clifford
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Australia.
| | - Nicole L Messina
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Australia.
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6
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Tola HH, Holakouie-Naieni K, Mansournia MA, Yaseri M, Tesfaye E, Mahamed Z, Molla Sisay M. Low enrollment and high treatment success in children with drug-resistant tuberculosis in Ethiopia: A ten years national retrospective cohort study. PLoS One 2020; 15:e0229284. [PMID: 32101580 PMCID: PMC7043800 DOI: 10.1371/journal.pone.0229284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background Limited evidence exists on the treatment outcome and factors that are associated with the duration from the initiation of treatment to death or treatment failure in children with drug resistant tuberculosis (DR-TB). Thus, we aimed to determine the proportion of treatment enrollment, status of treatment outcome and determine factors that are associated with the duration from treatment initiation to death or treatment failure in children treated for DR-TB in Ethiopia. Methods We conducted a retrospective cohort study in children younger than 15 years old who were treated for DR-TB from February 2009 to February 2019 in Ethiopia. We collected data on socio-demographic and clinical characteristics from clinical charts, registration books and laboratory result reports on 155 children. Proportion of enrollment to the treatment was calculated by dividing the total number of children who were receiving the treatment by the total number of DR-TB patients treated during the specified years. We used Cox proportional hazard models to determine factors that were associated with the duration from the beginning of the treatment to death or treatment failure. Data was analyzed using STATA version 14. Results Of the 3,478 DR-TB patients enrolled into the treatment and fulfilling our inclusion criteria during the past ten years, 155 (4.5%) were children. Of the 155 children, 75 (48.4%) completed the treatment and 51 (32.9%) were cured. Furthermore, 18 (11.6%) children were died, seven (4.5%) lost to follow up and treatment of four (2.6%) children was failed. The overall treatment success was 126 (81.3%). Age younger than 5 years old [Adjusted Hazard Ratio (AHR) = 3.2, 95%CI (1.2–8.3)], HIV sero-reactivity [AHR = 5.3, 95%CI (1.8–14.9)] and being anemic [AHR = 4.3, 95%CI (1.8–10.3)] were significantly associated with the duration from the enrollment into the treatment to death or treatment failure. Conclusion In this study, the proportion of children enrolled into DR-TB treatment was lower than the proportion of adults enrolled to the treatment (4.5% in children versus 95.5% in adults) in last ten years. Our findings also suggest that children with DR-TB can be successfully treated with standardized long term regimen. Further prospective cohort study is required to investigate factors contributing to death or treatment failure.
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Affiliation(s)
- Habteyes Hailu Tola
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), School of Public Health, Tehran, Iran
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), School of Public Health, Tehran, Iran
- * E-mail:
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), School of Public Health, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), School of Public Health, Tehran, Iran
| | - Ephrem Tesfaye
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zemedu Mahamed
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Million Molla Sisay
- Saint Peter’s Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia
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7
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Keshavjee S, Amanullah F, Cattamanchi A, Chaisson R, Dobos KM, Fox GJ, Gendelman HE, Gordon R, Hesseling A, Le Van H, Kampmann B, Kana B, Khuller G, Lewinsohn DM, Lewinsohn DA, Lin PL, Lu LL, Maartens G, Owen A, Protopopova M, Rengarajan J, Rubin E, Salgame P, Schurr E, Seddon JA, Swindells S, Tobin DM, Udwadia Z, Walzl G, Srinivasan S, Rustomjee R, Nahid P. Moving toward Tuberculosis Elimination. Critical Issues for Research in Diagnostics and Therapeutics for Tuberculosis Infection. Am J Respir Crit Care Med 2020; 199:564-571. [PMID: 30335466 DOI: 10.1164/rccm.201806-1053pp] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Salmaan Keshavjee
- 1 Harvard Medical School, Boston, Massachusetts.,2 Harvard Medical School Center for Global Health Delivery-Dubai, Dubai, United Arab Emirates
| | | | - Adithya Cattamanchi
- 4 University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Richard Chaisson
- 5 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Gregory J Fox
- 7 University of Sydney, Sydney, New South Wales, Australia
| | | | - Richard Gordon
- 9 South African Medical Research Council, Cape Town, Western Cape, South Africa
| | | | - Hoi Le Van
- 11 National Lung Hospital, Hanoi, Vietnam.,12 National TB Program in Vietnam, Hanoi, Vietnam
| | - Beate Kampmann
- 13 London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bavesh Kana
- 14 University of Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.,15 Centre for the AIDS Programme of Research in South Africa, CAPRISA, Durban, South Africa
| | - Gopal Khuller
- 16 Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David M Lewinsohn
- 17 Oregon Health & Science University, Portland, Oregon.,18 Portland VA Medical Center, Portland, Oregon
| | | | - Philiana Ling Lin
- 19 University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Lenette Lin Lu
- 20 Massachusetts General Hospital, Boston, Massachusetts
| | - Gary Maartens
- 21 Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew Owen
- 22 University of Liverpool, Liverpool, England
| | - Marina Protopopova
- 23 Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Department of Health and Human Services, Rockville, Maryland
| | | | - Eric Rubin
- 25 Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - James A Seddon
- 13 London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - David M Tobin
- 28 Duke University School of Medicine, Durham, North Carolina; and
| | - Zarir Udwadia
- 29 Hinduja Hospital & Research Center, Mumbai, India
| | - Gerhard Walzl
- 30 Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa.,14 University of Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Sudha Srinivasan
- 23 Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Department of Health and Human Services, Rockville, Maryland
| | - Roxana Rustomjee
- 23 Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Department of Health and Human Services, Rockville, Maryland
| | - Payam Nahid
- 4 University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
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8
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Claeys TA, Rosas Mejia O, Marshall S, Jarzembowski JA, Hayes D, Hull NM, Liyanage NPM, Chun RH, Sulman CG, Huppler AR, Robinson RT. Attenuation of Helper T Cell Capacity for TH1 and TH17 Differentiation in Children With Nontuberculous Mycobacterial Infection. J Infect Dis 2019; 220:1843-1847. [PMID: 31332447 DOI: 10.1093/infdis/jiz371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) infect children with increasing frequency worldwide. Using blood and lymph node tissue from children with NTM lymphadenitis, and uninfected lymph node tissue from community controls, we evaluated helper T (TH) cells in functional assays of TH1/TH17 differentiation and measured the concentration of their associated cytokines at the site of infection. Circulating TH cells from infected children were attenuated in their TH1/TH17 differentiation capacity and expressed less interferon γ and interleukin 17 after polyclonal stimulation. Similar differences were observed at the site of infection, where most cytokine concentrations were unchanged relative to controls. Our data are consistent with a model wherein TH1/TH17 differentiation is attenuated in NTM-infected children.
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Affiliation(s)
- Tiffany A Claeys
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus
| | - Oscar Rosas Mejia
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus
| | - Samuel Marshall
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee
| | - Jason A Jarzembowski
- Department of Pathology, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Don Hayes
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Natalie M Hull
- Department of Civil, Environmental, and Architectural Engineering, The Ohio State University, Columbus
| | - Namal P M Liyanage
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus
| | - Robert H Chun
- Division of Pediatric Otolaryngology, Department of Surgery, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee
| | - Cecille G Sulman
- Division of Pediatric Otolaryngology, Department of Surgery, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee
| | - Anna R Huppler
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee.,Division of Infectious Disease, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital and Health System, Children's Research Institute, Milwaukee
| | - Richard T Robinson
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus
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9
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The evolving research agenda for paediatric tuberculosis infection. THE LANCET. INFECTIOUS DISEASES 2019; 19:e322-e329. [PMID: 31221543 DOI: 10.1016/s1473-3099(18)30787-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/19/2018] [Accepted: 12/11/2018] [Indexed: 12/30/2022]
Abstract
Following exposure to tuberculosis and subsequent infection, children often progress to tuberculosis disease more rapidly than adults. And yet the natural history of tuberculosis in children, as a continuum from exposure to infection and then to disease, is poorly understood. Children are rarely diagnosed with tuberculosis infection in routine care in international settings and few receive tuberculosis infection treatment. In this Personal View, we review the most up-to-date knowledge in three areas of childhood tuberculosis infection-namely, pathophysiology, diagnosis, and treatment. We then outline what is missing in each of these three areas to generate a priority research agenda. Finally, we suggest potential study designs that might answer these questions. Understanding of pathophysiology could be improved through animal models, laboratory studies assessing the immunological responses of blood or respiratory samples to Mycobacterium spp in vitro, as well as investigating immune responses in children exposed to tuberculosis. Identification of children with sub-clinical disease and at high risk of progression to clinically overt disease, would allow treatment to be targeted at those most likely to benefit. Optimisation and discovery of novel treatments for tuberculosis infection in children should account for mechanisms of action of tuberculosis drugs, as well as child-specific factors including pharmacokinetics and appropriate formulations. To conduct these studies, a change in mindset is required, with a recognition that the diagnosis and treatment of tuberculosis infection in children is a necessary component in addressing the overall tuberculosis epidemic. Collaboration between stakeholders will be required and funding will need to increase, both for research and implementation. The consequences of inaction, however, will lead to further decades of children suffering from what should increasingly be recognised as a preventable disease.
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10
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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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11
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Suárez I, Maria Fünger S, Jung N, Lehmann C, Reimer RP, Mehrkens D, Bunte A, Plum G, Jaspers N, Schmidt M, Fätkenheuer G, Rybniker J. Severe disseminated tuberculosis in HIV-negative refugees. THE LANCET. INFECTIOUS DISEASES 2019; 19:e352-e359. [PMID: 31182290 DOI: 10.1016/s1473-3099(19)30162-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
In high-income countries, the presentation of tuberculosis is changing, primarily because of migration, and understanding the specific health needs of susceptible populations is becoming increasingly important. Although disseminated tuberculosis is well documented in HIV-positive patients, the disease is poorly described and less expected in HIV-negative individuals. In this Grand Round, we report eight HIV-negative refugees, who presented with extensively disseminated tuberculosis. We discuss the multifactorial causes, such as deprivations during long journeys, precarious living conditions, and the experience of violence, which might add to nutritional factors and chronic disorders, eventually resulting in a state of predisposition to immune deficiency. We also show that disseminated tuberculosis is often difficult to diagnose when pulmonary symptoms are absent. Communication difficulties between refugees and health-care workers are another major hurdle, and every effort should be made to get a valid patient history. This medical history is crucial to guide imaging and other diagnostic procedures to establish a definite diagnosis, which should be confirmed by a positive tuberculosis culture. Because many of these patients are at risk for multidrug-resistant tuberculosis, drug susceptibility testing is imperative to guide therapy. In the absence of treatment guidelines for this entity, clinicians can determine treatment duration according to recommendations provided for extrapulmonary tuberculosis and affected organs. Paradoxical expansion of tuberculous lesions during therapy should be treated with corticosteroids. In many cases, treatment duration must be individualised and might even exceed 12 months.
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Affiliation(s)
- Isabelle Suárez
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Sarah Maria Fünger
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Robert Peter Reimer
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Dennis Mehrkens
- Department of Cardiovascular Medicine, University Heart Center, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Anne Bunte
- Public Health Department Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Natalie Jaspers
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department for Nuclear Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
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12
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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13
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Bielecka T, Komorowska-Piotrowska A, Krenke K, Feleszko W, Kulus M. Is secretion of IFN-gamma in response to Mycobacterium tuberculosis antigens in youngest children sufficient to play a role in TB diagnostics? Pediatr Pulmonol 2018; 53:181-188. [PMID: 29136358 DOI: 10.1002/ppul.23910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/16/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess whether children ≤5 years of age, produce sufficient amounts of interferon gamma (IFN-ɣ) in response to phytohaemagglutinin (mitogen), and Mycobacterium tuberculosis antigens (TB antigens) in the QuantiFERON-TB Gold in-Tube test (QFT-GIT), (Cellestis Ltd., Australia). WORKING HYPOTHESIS Is TB-antigen-induced IFN-ɣ response in children ≤5 years sufficient to consider QFT-GIT a possible tool for TB diagnostics? Study design, patient-subject selection, and methods: We recruited children 0-17 years old suspected of TB infection to this cross-sectional study, in whom QFT-GIT and TST were performed. We analyzed the median IFN-ɣ levels in mitogen and TB antigen tubes in children ≤5 years and >5 years, and the correlation between IFN-ɣ level in both tubes and age. RESULTS A total of 153 children were enrolled, age median was 7.8 (IQR:8), 45 (29.4%) aged ≤5 years (median 3.4, IQR:1.7), 108 > 5 years (median 10.55, IQR:5.93). In the mitogen tubes, the median IFN-ɣ level was higher in children >5 years (median 17.87, IQR:2.1 vs 16.77, IQR:7.6), but surprisingly in the TB antigen tubes it was higher in the younger group (median 0.12, IQR:0.21vs 0.06, IQR:0.09, P = 0.04). We proved a positive correlation between IFN-ɣ level and age in mitogen tubes (r = 0.18, P = 0.03) and a negative correlation in TB antigen tubes (r = -0.17, P = 0.04). In latent tuberculosis infection patients, the latter correlation was found to be even stronger (r = -0.39, P = 0.01). CONCLUSIONS The youngest children release sufficient amount of IFN-ɣ in response to TB antigens thus QFT-GIT might be a useful tool for TB diagnostics in this age group.
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Affiliation(s)
- Teresa Bielecka
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Poland
| | | | - Katarzyna Krenke
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Poland
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Poland
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14
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Xue X, Qiu Y, Jiang D, Jin T, Yan M, Zhu X, Chu Y. The association analysis of TLR2 and TLR4 gene with tuberculosis in the Tibetan Chinese population. Oncotarget 2017; 8:113082-113089. [PMID: 29348888 PMCID: PMC5762573 DOI: 10.18632/oncotarget.22996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background The present study was undertaken to explore the relationship of Toll-like receptor (TLR) 2, TLR4 genes polymorphisms with Pulmonary tuberculosis (PTB) risk in a sample of Chinese population. Methods For this study, we recruited 467 subjects with PTB and 504 healthy subjects from a Tibetan population living in near or in Xi'an, China. Association analyses of single-nucleotide polymorphisms (SNPs) in TLR2 and TLR4 were performed with SPSS Statistics (version 17.0), SNPStats, Haploview (version 4.2), and SHEsis software. Results The research results that is association analysis of pulmonary tuberculosis show there are two increased-risk SNPs (rs7696323, OR=1.32, 95%CI =1.08-1.62, P= 0.007; rs12377632, OR=1.30, 95%CI =1.09-1.55, P= 0.004) and three decreased-risk SNPs (rs3804099, OR=0.64, 95%CI =0.52-0.79, P= 1.9510-5; rs3804100, OR=0.67, 95%CI =0.54-0.82, P= 0.0001; rs11536889, OR=0.54, 95%CI =0.42-0.69, P= 9.1410-7). Conclusions We found that two SNPs are associated with increased PTB risk and three SNPs decreased PTB risk in the Chinese Tibetan population. Our findings demonstrate an association between TLR2 and TLR4 polymorphisms and PTB.
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Affiliation(s)
- Xin Xue
- Department of Pathogen Biology and Immunology, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.,The Fourth Internal Medicine, Xi'an Chest Hospital, Xi'an TB and Thoracic Tumor Hospital, Xi'an 710100, China
| | - Yi Qiu
- The Second Internal Medicine, Xi'an Chest Hospital, Xi'an TB and Thoracic Tumor Hospital, Xi'an 710100, China
| | - Dong Jiang
- Inner Mongolia Medical University, Hohhot 010010, China
| | - Tianbo Jin
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, Xi'an 710069, China.,School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Mengdan Yan
- Key Laboratory of Resource Biology and Biotechnology in Western China (Northwest University), Ministry of Education, School of Life Sciences, Northwest University, Xi'an 710069, China
| | - Xikang Zhu
- School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Yonglie Chu
- Department of Pathogen Biology and Immunology, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
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15
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Golla V, Snow K, Mandalakas AM, Schaaf HS, Du Preez K, Hesseling AC, Seddon JA. The impact of drug resistance on the risk of tuberculosis infection and disease in child household contacts: a cross sectional study. BMC Infect Dis 2017; 17:593. [PMID: 28851285 PMCID: PMC5576070 DOI: 10.1186/s12879-017-2668-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background The relative fitness of organisms causing drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) is unclear. We compared the risk of TB infection and TB disease in young child household contacts of adults with confirmed DS-TB and MDR-TB. Methods In this cross-sectional analysis we included data from two community-based contact cohort investigation studies conducted in parallel in Cape Town, South Africa. Children <5 years of age with household exposure to an infectious TB case were included between August 2008 to June 2011. Children completed investigation for TB infection (tuberculin skin test) and TB disease (symptom evaluation, chest radiograph, bacteriology) in both studies using standard approaches. The impact of MDR-TB exposure on each covariate of TB infection and TB disease was assessed using univariable and multivariable logistic regression. Results Of 538 children included, 312 had DS-TB and 226 had MDR-TB exposure. 107 children with DS-TB exposure had TB infection (34.3%) vs. 101 (44.7%) of children with MDR-TB exposure (adjusted Odds Ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.34–3.12). A total of 15 (6.6%) MDR-TB vs. 27 (8.7%) DS-TB child contacts had TB disease at enrolment (aOR: 0.43; 95% CI: 0.19–0.97). Conclusions Our results suggest a higher risk of TB infection in child contacts with household MDR-TB vs. DS-TB exposure, but a lower risk of TB disease. Although potentially affected by residual confounding or selection bias, our results are consistent with the hypothesis of impaired virulence in MDR-TB strains in this setting.
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Affiliation(s)
- Vera Golla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa
| | - Kathryn Snow
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Anna M Mandalakas
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa.
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000, Cape Town, South Africa. .,Centre for International Child Health, Department of Paediatrics, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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16
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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17
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Whittaker E, Nicol M, Zar HJ, Kampmann B. Regulatory T Cells and Pro-inflammatory Responses Predominate in Children with Tuberculosis. Front Immunol 2017; 8:448. [PMID: 28487695 PMCID: PMC5403917 DOI: 10.3389/fimmu.2017.00448] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/31/2017] [Indexed: 01/09/2023] Open
Abstract
Background Following infection with Mycobacterium tuberculosis (M.tb), children are more susceptible to develop disease particularly extrapulmonary disease than adults. The exact mechanisms required for containment of M.tb are not known, but would be important to identify correlates of protection. Objective To comprehensively analyze key immune responses to mycobacteria between HIV-negative children with extrapulmonary TB (EPTB) compared to children with pulmonary TB (PTB) or healthy controls. Methods Whole blood was stimulated in vitro with mycobacteria for 24 h or 6 days to induce effector and memory responses. CD4, CD8, γδ, regulatory T cells, and their related cytokines were measured. Samples of children with tuberculosis (TB) disease were analyzed both at time of diagnosis and at the end of TB treatment to determine if any differences were due to TB disease or an underlying host phenotype. Results Seventy-six children with TB disease (48 with PTB and 28 with EPTB) and 83 healthy controls were recruited to the study. The frequency of CD4+CD25+CD39+FOXP3+ regulatory T cells and secreted IL10 were significantly higher in children with TB compared to healthy controls. IFNγ-, IL17-, and IL22-producing γδ T cells, IL22-producing CD4+ T cells and secreted pro-inflammatory cytokines (IFNγ, IL1β, and TNFα) were significantly lower in children with TB disease compared to healthy controls. IFNγ-producing CD4+ T cells and Ki67+-proliferating CD4+ T cells, however, were present in equal numbers in both groups. Following treatment, these immune parameters recovered to “healthy” levels or greater in children with PTB, but not those with extrapulmonary TB. Conclusion In children with TB disease, a predominantly immune regulatory state is present. These immune findings do not distinguish between children with PTB and EPTB at the time of diagnosis. Following treatment, these inflammatory responses recover in PTB, suggesting that the effect is disease specific rather than due to an underlying host defect.
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Affiliation(s)
- Elizabeth Whittaker
- Academic Department of Paediatrics, Imperial College London, London, UK.,UCT Faculty of Health Sciences, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - Mark Nicol
- UCT Faculty of Health Sciences, Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - Heather J Zar
- MRC Unit of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Beate Kampmann
- Academic Department of Paediatrics, Imperial College London, London, UK.,Vaccines and Immunity Theme, MRC Unit The Gambia, Fajara, Gambia
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18
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Mulenga CM, Kayembe JMN, Kabengele BO, Bakebe A. Anemia and Hematologic Characteristics in Newly Diagnosed Pulmonary Tuberculosis Patients at Diagnosis in Kinshasa. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jtr.2017.54026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Abstract
We have explored the added value of interferon-γ (IFNγ)-inducible protein 10 as a read-out of Mycobacterium tuberculosis-specific immunity in young Indian children, where the sensitivity of the IFNγ release assays for tuberculosis is poor. Reduced frequency of indeterminate results and an increased sensitivity for tuberculosis suggest a potential for fewer missed cases with a combined IFNγ/inducible protein 10 read-out in a 4th generation IFNγ release assays.
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20
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Castillo Avila IY, Hernández Escolar J, Alvis Estrada LR. Effectiveness of an Educational Program on Childhood Tuberculosis Supported on Information and Communication Technologies Aimed at Community Mothers from Cartagena. INVESTIGACION Y EDUCACION EN ENFERMERIA 2016; 34:465-473. [PMID: 29737719 DOI: 10.17533/udea.iee.v34n3a05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2016] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of an educational program using ICT to improve knowledge on childhood tuberculosis, in Family Women and Childhood (FAMI, for the term in Spanish) of Cartagena (Colombia). METHODS A controlled and randomize prevention trial without blinding was conducted on a sample of 50 community mothers from a location in Cartagena. The educational program combined five face meetings and support from information and communication technologies (ICT). With the control group only five education sessions were developed. RESULTS The average number of users in charge per community mother corresponds to 11 and the average number of children in charge was eight. Although in both groups the total score from the pretest to the post-test was improved (Intervention = 29.9 to 38.2, and Control = 31.9 to 36.8), this difference in the total and by modules was higher in the intervention group. Module 5 of Activities to identify suspected cases, monitor children, and care routes obtained in both groups the biggest difference in score between the pre- and post-test moments. C. CONCLUSIONS The education strategy that involved the virtual information component resulted significantly more effective to improve knowledge than the traditional education strategy.
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21
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Seddon JA, Paton J, Nademi Z, Keane D, Williams B, Williams A, Welch SB, Liebeschutz S, Riddell A, Bernatoniene J, Patel S, Martinez-Alier N, McMaster P, Kampmann B. The impact of BCG vaccination on tuberculin skin test responses in children is age dependent: evidence to be considered when screening children for tuberculosis infection. Thorax 2016; 71:932-9. [PMID: 27335104 PMCID: PMC5036222 DOI: 10.1136/thoraxjnl-2015-207687] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/28/2016] [Indexed: 11/21/2022]
Abstract
Background Following exposure to TB, contacts are screened to target preventive treatment at those at high risk of developing TB. The UK has recently revised its recommendations for screening and now advises a 5 mm tuberculin skin test (TST) cut-off irrespective of age or BCG status. We sought to evaluate the impact of BCG on TST responses in UK children exposed to TB and the performance of different TST cut-offs to predict interferon γ release assay (IGRA) positivity. Methods Children <15 years old were recruited from 11 sites in the UK between January 2011 and December 2014 if exposed in their home to a source case with sputum smear or culture positive TB. Demographic details were collected and TST and IGRA undertaken. The impact of BCG vaccination on TST positivity was evaluated in IGRA-negative children, as was the performance of different TST cut-offs to predict IGRA positivity. Results Of 422 children recruited (median age 69 months; IQR: 32–113 months), 300 (71%) had been vaccinated with BCG. BCG vaccination affected the TST response in IGRA-negative children less than 5 years old but not in older children. A 5 mm TST cut-off demonstrated good sensitivity and specificity in BCG-unvaccinated children, and an excellent negative predictive value but was associated with low specificity (62.7%; 95% CI 56.1% to 69.0%) in BCG-vaccinated children. For BCG-vaccinated children, a 10 mm cut-off provided a high negative predictive value (97.7%; 95% CI 94.2% to 99.4%) with the positive predictive value increasing with increasing age of the child. Discussion BCG vaccination had little impact on TST size in children over 5 years of age. The revised TST cut-off recommended in the recent revision to the UK TB guidelines demonstrates good sensitivity but is associated with impaired specificity in BCG-vaccinated children.
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Affiliation(s)
- James A Seddon
- Department of Academic Paediatrics, Centre of International Child Health, Imperial College London, London, UK
| | - James Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Zohreh Nademi
- Department of Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, Tyne and Wear, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Denis Keane
- Department of Academic Paediatrics, Centre of International Child Health, Imperial College London, London, UK
| | - Bhanu Williams
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, Middlesex, UK
| | - Amanda Williams
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, Middlesex, UK
| | - Steven B Welch
- Birmingham Chest Clinic, Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Sue Liebeschutz
- Department of Paediatrics, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Anna Riddell
- The Children's Hospital at the Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jolanta Bernatoniene
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol, UK
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Nuria Martinez-Alier
- Department of Paediatric Infectious Diseases, Evelina Children's Hospital, London, UK
| | - Paddy McMaster
- Department of Paediatric Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - Beate Kampmann
- Department of Academic Paediatrics, Centre of International Child Health, Imperial College London, London, UK Vaccines & Immunity Theme, Medical Research Council Unit, Atlantic Boulevard, Fajara, The Gambia
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22
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Hoagland D, Zhao Y, Lee RE. Advances in Drug Discovery and Development for Pediatric Tuberculosis. Mini Rev Med Chem 2016; 16:481-97. [PMID: 26202201 PMCID: PMC4964275 DOI: 10.2174/1389557515666150722101723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/11/2015] [Accepted: 07/12/2015] [Indexed: 01/28/2023]
Abstract
Pediatric tuberculosis is an underappreciated global epidemic estimated to afflict around half a million children worldwide. This problem has historically been overlooked, due in part to their low social status and the difficulty in diagnosis of tuberculosis in children. Children are more susceptible to tuberculosis infection and disease progression, including rapid dissemination into extrapulmonary infection sites. Treatment of pediatric tuberculosis infections has been traditionally built around agents used to treat the adult disease, but the disease pathology, drug pharmacokinetics and the safety window in children differs from the adult disease. This produces additional concerns for drug discovery and development of new agents. This review examines: (i) the safety concerns for current front and second line agents used to treat complex drug resistant infections and how this knowledge can be used to identify, prioritize and dose agents that may be better tolerated in pediatric populations; and (ii) the chemistry and suitability of new drugs in the clinical development pipeline for tuberculosis for the treatment of pediatric infections indicating several new agents may offer significant improvements for the treatment of multi-drug resistant tuberculosis in children.
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Affiliation(s)
| | | | - Richard E Lee
- Department of Chemical Biology and Therapeutics, St Jude Children's Research Hospital, MS#1000, Memphis, TN 38105, USA.
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23
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Seddon JA, Kampmann B. HIV and tuberculosis in children: biology meets epidemiology. Lancet HIV 2015; 2:e506-7. [PMID: 26614962 DOI: 10.1016/s2352-3018(15)00209-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- James A Seddon
- Department of Academic Paediatrics, Imperial College London, London, UK.
| | - Beate Kampmann
- Department of Academic Paediatrics, Imperial College London, London, UK; Vaccines & Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
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Herzmann C, Sotgiu G, Schaberg T, Ernst M, Stenger S, Lange C. Childhood BCG vaccination does not influence control of Mycobacterium tuberculosis growth by human bronchoalveolar lavage cells. Tuberculosis (Edinb) 2015; 95:321-7. [PMID: 25794470 DOI: 10.1016/j.tube.2015.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Childhood vaccination with Mycobacterium bovis Bacille Calmette-Guérin (BCG) reduces the risk of infection with Mycobacterium tuberculosis and the risk of severe forms of tuberculosis in children. The protection of adults from pulmonary tuberculosis is doubtful. This study evaluated the effect of the vaccination on the growth of M. tuberculosis human bronchoalveolar mononuclear cells (BALMC). METHODS Healthy, adult healthcare workers who were regularly exposed to M. tuberculosis, household tuberculosis contacts, and cured tuberculosis patients were recruited in a multicentre study conducted in Germany. BALMC were co-cultured with different strains of M. tuberculosis in growth inhibition assays (MGIAs). RESULTS MGIAs on BALMC were conducted in 90 contact persons (known vaccination status, n = 75) and 62 former tuberculosis patients (known status, n = 22). Growth rates for M. tuberculosis H37Rv in BALMC were independent of the vaccination status, both in healthy contacts and in cured tuberculosis patients. This finding was validated in growth inhibition assays using two different Haarlem M. tuberculosis outbreak strains. Subgroup analyses based on the Interferon-gamma release assay status found no impact of the vaccination on mycobacterial growth. CONCLUSIONS This study suggests that M. bovis BCG vaccination does not alter the anti-mycobacterial capacity of BALMC as assessed in ex-vivo growth inhibition assays.
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Affiliation(s)
- Christian Herzmann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; Center for Clinical Studies, Research Center Borstel, Borstel, Germany.
| | - 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.
| | - Tom Schaberg
- Center of Pneumology, Deaconess Hospital Rotenburg, Rotenburg, Germany.
| | - Martin Ernst
- Division of Immune-Cell Analytics, Research Center Borstel, Borstel, Germany.
| | - Steffen Stenger
- Institute for Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany.
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Germany; International Health/Infectious Diseases, University of Lübeck, Germany; Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia; Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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25
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Holm LL, Rose MV, Kimaro G, Bygbjerg IC, Mfinanga SG, Ravn P, Ruhwald M. A comparison of interferon-γ and IP-10 for the diagnosis of tuberculosis. Pediatrics 2014; 134:e1568-75. [PMID: 25422019 DOI: 10.1542/peds.2014-1570] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Interferon-γ and IP-10 release assays are diagnostic tests for tuberculosis infection. We have compared the accuracy of IP-10 and QuantiFERON-TB Gold In-tube [QFT-IT] in Tanzanian children suspected of having active tuberculosis (TB). METHODS Hospitalized Tanzanian children with symptoms of TB were tested with the QFT-IT and IP-10 tests and retrospectively classified into diagnostic groups. Adults with confirmed TB were assessed in parallel. RESULTS A total of 203 children were included. The median age was 3.0 years (interquartile range: 1.2-7.0), 38% were HIV infected, 36% were aged <2 years, and 58% had a low weight-for-age. IP-10 and QFT-IT test performance was comparable but sensitivity was low: 33% (1 of 3) in children with confirmed TB and 29% (8 of 28) in children with probable TB. Rates of indeterminate responders were high: 29% (59 of 203) for IP-10 and 26% (53 of 203) for QFT-IT. Age <2 years was associated with indeterminate test outcome for both IP-10 (adjusted odds ratio [aOR]: 2.2; P = .02) and QFT-IT (aOR: 2.4; P = .01). TB exposure was associated with positive IP-10 test outcome (aOR: 3.6; P = .01) but not with positive QFT-IT outcome (aOR 1.4; P = .52). In 102 adults, test sensitivity was 80% for both tests (P = .248). CONCLUSIONS Although IP-10 and QFT-IT performed well in Tanzanian adults, the tests exhibited an equally poor performance in diagnosing active TB in children. Test performance was especially compromised in young children. Neither test can be recommended for use in hospitalized children in high-burden settings.
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Affiliation(s)
| | - Michala Vaaben Rose
- Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Godfather Kimaro
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Ib C Bygbjerg
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Pernille Ravn
- Clinical Research Centre, and Department for Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; and
| | - Morten Ruhwald
- Department of Infectious Disease Immunology, Statens Serum Institute, Copenhagen, Denmark
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Influence of age and nutritional status on the performance of the tuberculin skin test and QuantiFERON-TB gold in-tube in young children evaluated for tuberculosis in Southern India. Pediatr Infect Dis J 2014; 33:e260-9. [PMID: 24797993 PMCID: PMC4165482 DOI: 10.1097/inf.0000000000000399] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFNγ-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis' IFNγ-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested. METHODS During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm. RESULTS Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19-5.06), OR 3.08 (1.10-8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06-0.47)]. CONCLUSION The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting.
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Herzmann C, Sotgiu G, Schaberg T, Ernst M, Stenger S, Lange C. Early BCG vaccination is unrelated to pulmonary immunity against Mycobacterium tuberculosis in adults. Eur Respir J 2014; 44:1087-90. [PMID: 24969658 DOI: 10.1183/09031936.00086514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christian Herzmann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany Center for Clinical Studies, Research Center Borstel, Borstel, Germany
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Tom Schaberg
- Center of Pneumology, Agaplesion Deaconess Hospital Rotenburg, Rotenburg, Germany
| | - Martin Ernst
- Division of Immune-Cell Analytics, Research Center Borstel, Borstel, Germany
| | - Steffen Stenger
- Institute for Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany Dept of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
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28
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Tuberculosis Immune Reconstitution Inflammatory Syndrome in children initiating Antiretroviral Therapy for HIV infection: A systematic literature review. Pediatr Infect Dis J 2014; 33:499-503. [PMID: 24736441 PMCID: PMC4121969 DOI: 10.1097/inf.0000000000000142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with HIV initiating combination antiretroviral therapy are at risk for tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS). While this syndrome has been well researched in adults, little is known about the incidence, case fatality, underlying immunopathology and treatment approaches in children. METHODS Major databases were searched for articles related to TB-IRIS in children. Data were abstracted using standardized forms. RESULTS Thirteen studies were identified: 6 retrospective and 2 prospective cohort studies, 1 cross-sectional study, 3 case reports and 1 case series. In total, 303 cases of TB-IRIS were described, of which 270 were unmasking TB-IRIS, 12 paradoxical TB-IRIS and 21 were not classifiable due to lack of key information. None of the cohort studies had investigation of TB-IRIS as its primary aim. Nine studies were from Africa, 3 from Asia and 1 from Latin America. Age at cART initiation (reported by 12 studies) ranged from 1 month to 16 years. Median time from start of cART to IRIS diagnosis (reported by 8 studies) ranged from 8 days to 16 weeks. Few deaths attributable to TB-IRIS were recorded. Treatment was only discussed in 2 case studies, both of which reported children receiving corticosteroids. No studies evaluated risk factors for, or immunopathogenesis of, pediatric TB-IRIS. CONCLUSIONS There is a paucity of information available on TB-IRIS in children. Future research assessing incidence, risk factors, case fatality and optimal treatment or prevention strategies of TB-IRIS is needed.
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Using fluorescence correlation spectroscopy (FCS) for IFN-g detection: a preliminary study. J Immunol Methods 2014; 407:35-9. [PMID: 24685834 DOI: 10.1016/j.jim.2014.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/10/2014] [Accepted: 03/19/2014] [Indexed: 11/22/2022]
Abstract
Nowadays, enzyme-linked immunosorbent assay (ELISA) based detection of Mycobacterium tuberculosis (M. tuberculosis) antigen triggered interferon-gamma (IFN-g) secretion by blood T cells displays an improved diagnostic value for M. tuberculosis infection. Applications of fluorescence correlation spectroscopy (FCS) have been explored in various subfields of medicine and molecular biology, including detection of a certain biomarker in liquid instead of ELISA. Here, we present a preliminary study of detecting IFN-g using FCS-based technique.
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Sanchini A, Fiebig L, Drobniewski F, Haas W, Richter E, Katalinic-Jankovic V, Pimkina E, Skenders G, Cirillo DM, Balabanova Y. Laboratory diagnosis of paediatric tuberculosis in the European Union/European Economic Area: analysis of routine laboratory data, 2007 to 2011. ACTA ACUST UNITED AC 2014; 19. [PMID: 24679723 DOI: 10.2807/1560-7917.es2014.19.11.20744] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laboratory confirmation of paediatric tuberculosis (TB) is frequently lacking. We reviewed the range of routine laboratory tests and their performance in different biological samples used to diagnose active TB in children. A questionnaire-based survey was conducted among the European Reference Laboratory Network for TB followed by collection of routine laboratory data on 10,549 paediatric samples tested in 2007 to 2011 at six reference laboratories (in Croatia, Germany, Italy, Latvia, Lithuania and the United Kingdom (UK)). The questionnaire showed that all laboratories used rapid assays. Non-respiratory samples were collected more often in Germany (135/275, 49.1%) and the UK (490/2,140, 22.9%) compared with Croatia (138/2,792, 4.9%), Latvia (222/2,401, 9.2%) and Lithuania (76/1,549, 4.9%). Overall laboratory positivity rates (isolation of Mycobacterium tuberculosis complex and/or identification of its nucleic acids in a sample) were higher in lymph node and gastric aspirate samples (14/203 (6.9%) and 43/1,231 (3.5%)) than in sputum samples (89/4,684 (1.9%)). Pooled sensitivity, specificity, positive and negative predictive values and accuracy of molecular assays assessed against solid or liquid culture were 79.2%, 93.6%, 67.1%, 96.5% and 91.6%, respectively. A more intensive approach in obtaining gastric aspirate and non-respiratory samples may increase laboratory confirmation of paediatric TB. Major effort is needed in optimisation and validation of molecular tests in these samples.
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Affiliation(s)
- A Sanchini
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Qi H, Sun L, Jin YQ, Shen C, Chu P, Wang SF, Yin QQ, Qi Z, Xu F, Jiao WW, Wu XR, Tian JL, Xiao J, Shen AD. rs2243268 and rs2243274 of Interleukin-4 (IL-4) gene are associated with reduced risk for extrapulmonary and severe tuberculosis in Chinese Han children. INFECTION GENETICS AND EVOLUTION 2014; 23:121-8. [PMID: 24518693 DOI: 10.1016/j.meegid.2014.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Interleukin-4 (IL-4) and IL-10, which are produced by Th2 cells, serve as anti-inflammatory cytokines in the immune responses to tuberculosis (TB). In order to investigate the association between susceptibility to TB and single-nucleotide polymorphisms (SNPs) of the IL-4 and IL-10 genes, a case-control study including 346 TB patients and 374 healthy controls was performed in Chinese Han children in North China. Though no significant differences in the allelic and genotypic distributions of SNPs of these two genes were observed between control group and TB group, rs2243268-A and rs2243274-G of the IL-4 gene were associated with reduced risk of developing extrapulmonary tuberculosis (EPTB) (Prs2243268=0.005 and Prs2243274=0.004) and severe TB (Prs2243268=0.003 and Prs2243274=0.003). The haplotype comprising rs2243268-A and rs2243274-G was found to be a resistance factor against EPTB and severe TB. In addition, after stimulation with inactivated H37Rv, blood samples of the rs2243268 AA+AC carriers showed significantly reduced IL-10 production (P=0.045) compared to the CC carriers. In conclusion, rs2243268-A and rs2243274-G of the IL-4 gene were found to confer resistance to EPTB and severe TB in Chinese Han children.
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Affiliation(s)
- Hui Qi
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Lin Sun
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Ya-Qiong Jin
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Chen Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Ping Chu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Sheng-Feng Wang
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Qing-Qin Yin
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Zhan Qi
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Fang Xu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Wei-Wei Jiao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Xi-Rong Wu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Jian-Ling Tian
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - Jing Xiao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China
| | - A-Dong Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, No. 56, Nan-li-shi Road, Beijing 100045, China.
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de Martino M, Galli L, Chiappini E. Reflections on the immunology of tuberculosis: will we ever unravel the skein? BMC Infect Dis 2014; 14 Suppl 1:S1. [PMID: 24564297 PMCID: PMC4015689 DOI: 10.1186/1471-2334-14-s1-s1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Many and large dumps exist in our knowledge about Mycobacterium tuberculosis infection and disease in infants and children. We still do not understand why some individuals do acquire and others do not acquire the infection in the presence of the same risk factors. We do not understand why some individuals convert from latent to active tuberculosis and why other individuals convert from active to inactive tuberculosis even without treatment. As a matter of fact the immune system mounts a bouncing, robust and polyedral defence against Mycobacterium tuberculosis, but the bacillus is so much artful and dextrous that it has ahead from this immunological fierce accoutrements. Mycobacterium tuberculosis survival, multiplication, and transmission are largely favoured by the immune mechanisms. The granuloma itself is more bacillus- than host-protective. These abilities make Mycobacterium tuberculosis one of more successful human pathogens, but dumps in our knowledge and the counterproductive immunity hinder development of new diagnostics, therapies and vaccines. This occurs in front of an infection which engages one third of the world population and a disease which kills in a year about 1.5 million individuals worldwide. Understanding mechanisms and meaning of immune response in tuberculosis marks out the foundations of strategies with a view to prepare effective vaccines and reliable diagnostic tools as well as to build up therapeutic weapons. To gain these objectives is vital and urgent considering that tuberculosis is a common cause of morbidity and is a leading cause of death.
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33
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Jaganath D, Mupere E. Childhood tuberculosis and malnutrition. J Infect Dis 2012; 206:1809-15. [PMID: 23033147 PMCID: PMC3502375 DOI: 10.1093/infdis/jis608] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/13/2012] [Indexed: 01/05/2023] Open
Abstract
Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease.
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Affiliation(s)
- Devan Jaganath
- David Geffen School of Medicine at the University of California, Los Angeles
- Tuberculosis Research Unit (TBRU), Case Western Reserve University, Cleveland, Ohio
| | - Ezekiel Mupere
- Makerere University, Kampala, Uganda
- Tuberculosis Research Unit (TBRU), Case Western Reserve University, Cleveland, Ohio
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Chegou NN, Essone PN, Loxton AG, Stanley K, Black GF, van der Spuy GD, van Helden PD, Franken KL, Parida SK, Klein MR, Kaufmann SHE, Ottenhoff THM, Walzl G. Potential of host markers produced by infection phase-dependent antigen-stimulated cells for the diagnosis of tuberculosis in a highly endemic area. PLoS One 2012; 7:e38501. [PMID: 22693640 PMCID: PMC3367928 DOI: 10.1371/journal.pone.0038501] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/10/2012] [Indexed: 11/25/2022] Open
Abstract
Background Recent interferon gamma (IFN-γ)-based studies have identified novel Mycobacterium tuberculosis (M.tb) infection phase-dependent antigens as diagnostic candidates. In this study, the levels of 11 host markers other than IFN-γ, were evaluated in whole blood culture supernatants after stimulation with M.tb infection phase-dependent antigens, for the diagnosis of TB disease. Methodology and Principal Findings Five M.tb infection phase-dependent antigens, comprising of three DosR-regulon-encoded proteins (Rv2032, Rv0081, Rv1737c), and two resucitation promoting factors (Rv0867c and Rv2389c), were evaluated in a case-control study with 15 pulmonary TB patients and 15 household contacts that were recruited from a high TB incidence setting in Cape Town, South Africa. After a 7-day whole blood culture, supernatants were harvested and the levels of the host markers evaluated using the Luminex platform. Multiple antigen-specific host markers were identified with promising diagnostic potential. Rv0081-specific levels of IL-12(p40), IP-10, IL-10 and TNF-α were the most promising diagnostic candidates, each ascertaining TB disease with an accuracy of 100%, 95% confidence interval for the area under the receiver operating characteristics plots, (1.0 to 1.0). Conclusions Multiple cytokines other than IFN-γ in whole blood culture supernatants after stimulation with M.tb infection phase-dependent antigens show promise as diagnostic markers for active TB. These preliminary findings should be verified in well-designed diagnostic studies employing short-term culture assays.
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Affiliation(s)
- Novel N Chegou
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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