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Alawi MM, Alserehi HA, Ali AO, Albalawi AM, Alanizi MK, Nabet FM, Alkamaly MA, Assiri AM, Jokhdar H, Qutub MO, khoja MA, Azhar EI, Taskandi WA, Sindi AA, Yasir M. Epidemiology of tuberculosis in Saudi Arabia following the implementation of end tuberculosis strategy: Analysis of the surveillance data 2015-2019. Saudi Med J 2024; 45:60-68. [PMID: 38220236 PMCID: PMC10807673 DOI: 10.15537/smj.2024.45.1.20230424] [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: 09/28/2023] [Accepted: 11/06/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To analyze the evolution of tuberculosis (TB) epidemiology in Saudi Arabia in the 5 years following the implementation of the end-TB Strategy. METHODS A retrospective analysis of surveillance data, reported by the national tuberculosis control program from 2015-2019, was carried out. The annual incidence and the percentage of yearly changes were calculated and compared to the World Health Organization (WHO) milestones, which anticipate a 4-5% annual decline. Additionally, various other epidemiological indicators of TB were examined. RESULTS The national TB incidence declined from 10.55% per 100,000 in 2015 to 8.76% per 100,000 in 2019, aligning with the WHO's 2019 milestone estimated between 8.59-8.96% per 100,000. While Makkah Region (40.3%) and Riyadh (24.6%) accounted for the majority of cases, Jazan region consistently exhibited the highest incidence throughout the study period. Demographic features shifted towards a younger age category, male, and native dominance. There was a consistent decrease in resistance and intermediate sensitivity to all first-line anti-TB drugs, associated with a substantial decrease in both polydrug resistance (from 4.7-1.9%; p<0.001) and multidrug resistance (from 4.4-2.4%; p=0.008). CONCLUSION The figures of TB incidence TB in Saudi Arabia between 2015-2019 has met the WHO end-TB milestones, predicting successful progress toward the 2035 goal.
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Affiliation(s)
- Maha M. Alawi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Haleema A. Alserehi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Ahmed O. Ali
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Abeer M. Albalawi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Mashael K. Alanizi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Fatima M. Nabet
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Modhi A. Alkamaly
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Abdullah M. Assiri
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Hani Jokhdar
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Mohammed O. Qutub
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Moahmmed A. khoja
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Esam I. Azhar
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Wael A. Taskandi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Annes A. Sindi
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Muhammad Yasir
- From the Department of Medical Microbiology and Parasitology (Alawi); from the Special Infectious Agents Unit (Azhar, Yasir), King Fahd Medical Research Center; from the Department of Medical Laboratory Technology (Azhar), Faculty of Applied Medical Sciences; from the Department of Surgery (Taskandi); from the Department of Anaesthesia and Critical Care (Sindi), Faculty of Medicine, King Abdulaziz University, from the Infection Control and Environmental Health Unit (Alawi), Faculty of Medicine, King Abdulaziz University Hospital, from the Department of Pulmonary & Critical Care (Sindi), International Medical Center, Jeddah, from the General Directorate of Infectious Disease Control and Prevention (Alserehi); from the National Tuberculosis Program (Ali, Albalawi, Alanizi, Nabet, Alkamaly, Assiri), General Directorate of Infectious Disease Control and Prevention; from the Public Health Directorate (Jokhdar), Ministry of Health, from the Department of Pathology and Laboratory Medicine (Qutub), King Faisal Specialist Hospital and Research Center, Riyadh, and from the Department of Infectious Disease (khoja), Madinah General Hospital, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
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2
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Cherkos AS, LaCourse SM, Enquobahrie DA, Escudero JN, Mecha J, Matemo D, Kinuthia J, John-Stewart G. Isoniazid preventive therapy during infancy does not adversely effect growth among HIV-exposed uninfected children: secondary analysis of data from a randomized controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.19.23297259. [PMID: 37905041 PMCID: PMC10614991 DOI: 10.1101/2023.10.19.23297259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Isoniazid preventive therapy (IPT) decreases risk of tuberculosis (TB) disease; impact on long-term infant growth is unknown. In a recent randomized trial (RCT), we assessed IPT effects on infant growth without known TB exposure. Methods The infant TB Infection Prevention Study (iTIPS) trial was a non-blinded RCT among HIV-exposed uninfected (HEU) infants in Kenya. Inclusion criteria included age 6-10 weeks, birthweight ≥2.5 kg, and gestation ≥37 weeks. Infants in the IPT arm received 10 mg/kg isoniazid daily for 12 months, while the control trial received no intervention; post-trial observational follow-up continued through 24 months of age. We used intent-to-treat linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) between trial arms. Results Among 298 infants, 150 were randomized to IPT, 47.6% were females, median birthweight was 3.4 kg (interquartile range [IQR] 3.0-3.7), and 98.3% were breastfed. During the 12-month intervention period and 12-month post-RCT follow-up, WAZ and HAZ declined significantly in all children, with more HAZ decline in male infants. There were no growth differences between trial arms, including in sex-stratified analyses. In longitudinal linear analysis, mean WAZ (β=0.04 [95% CI:-0.14, 0.22]), HAZ (β=0.14 [95% CI:-0.06, 0.34]), and WHZ [β=-0.07 [95% CI: -0.26, 0.11]) z-scores were similar between arms as were WAZ and HAZ growth trajectories. Infants randomized to IPT had higher monthly WHZ increase (β to 24 months 0.02 [95% CI:0.01, 0.04]) than the no-IPT arm. Conclusion IPT administered to HEU infants did not significantly impact growth outcomes in the first two years of life.
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Affiliation(s)
- Ashenafi S Cherkos
- Biostatistics and Epidemiology Department, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sylvia M LaCourse
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Jaclyn N Escudero
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Jerphason Mecha
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel Matemo
- Medical Research Department, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Medical Research Department, Kenyatta National Hospital, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Dejene TA, Hailu GG, Kahsay AG, Wasihun AG. Pulmonary Tuberculosis and Rifampicin Resistant Mycobacterium Tuberculosis in Children and Adolescents using Gene Xpert MTB/RIF Assay in Tigray, Northern Ethiopia. Infect Drug Resist 2023; 16:6757-6765. [PMID: 37876859 PMCID: PMC10591601 DOI: 10.2147/idr.s433789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Background Tuberculosis (TB) continues to be a global health problem. While childhood TB contributes 10% to the global TB burden, the paucibacillary nature of TB disease in children and the absence of reliable diagnostic methods have made MTB diagnosis in children to be a great challenge. This study aimed to determine the prevalence of MTB and rifampicin-resistant MTB (RR-MTB) among children using Gene Xpert MTB/RIF Assay in Tigray, Ethiopia. Methods A retrospective database study was conducted among children in ten governmental hospitals in the Tigray region. Gene Xpert MTB/RIF results of sputum/gastric lavage samples from children with presumptive TB from January 2016 to December 2019 were extracted using a data extraction sheet. Data were collected and analyzed using Statistical Package for the Social Sciences version 21. Results The prevalence of bacteriologically confirmed MTB by Gene-Xpert in children with presumptive TB was 7.3% (95% CI: 6.7%-7.9%) and the proportion of those that were Gene-Xpert MTB positive who also have rifampicin resistance was 10.9% (95% CI: 8.2-13.6%). Older children aged 11-15 years [AOR = 1.76; 95% CI = 1.33-2.33, p < 0.001] and adolescents 16-17 years [AOR = 2.18; 95% CI = 1.63-2.92, p < 0.001] were more likely to be MTB positive. Relapse cases [AOR = 1.66; 95% CI = 1.09-2.51, p = 0.017] and lost/failure cases [AOR = 8.82; 95% CI = 3.94-19.76, p < 0.001] were more likely to have MTB compared to the new cases. Conclusion The proportion of MTB-positive among the TB presumptive patients was 7.3%. The proportion of rifampicin-resistant TB to all positive patients was 10.9%. Female participants had more MTB than males (or younger children). The result highlights the need for due attention in children because it is very helpful in determining the future control of the disease.
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Affiliation(s)
- Tsehaye Asmelash Dejene
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Department of Medical Microbiology, School of Medicine, Aksum University, Axum, Ethiopia
| | - Genet Gebrehiwet Hailu
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Atsebaha Gebrekidan Kahsay
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Araya Gebreyesus Wasihun
- Department of Medical Microbiology and Immunology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Sajjad F, Baloch MF, Ashraf M, Gillespie CS, Umar H, Zafar A, Zulfiqar J, Ullah I, Ali S, Ashraf N. Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: A diagnostic challenge in an immunocompetent pediatric patient. Surg Neurol Int 2023; 14:350. [PMID: 37810325 PMCID: PMC10559370 DOI: 10.25259/sni_581_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable.
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Affiliation(s)
- Fauzia Sajjad
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | | | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Hira Umar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Ammara Zafar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Javaria Zulfiqar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Imdad Ullah
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sundus Ali
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
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Zhu J, Chen N, Shang Y, Feng Y. Case report: Miliary tuberculosis complicated by pediatric acute respiratory distress syndrome in a 12-year-old girl. Front Pediatr 2023; 11:1189838. [PMID: 37732009 PMCID: PMC10507688 DOI: 10.3389/fped.2023.1189838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a rare complication of miliary tuberculosis, particularly in pediatric patients. Comorbidities and delayed diagnosis can worsen the prognosis of patients with miliary tuberculosis. A 12-year-old girl presented with fever for 20 days, and cough and tachypnea for 4 days. She was diagnosed with miliary tuberculosis complicated by pediatric ARDS. She had atypical clinical manifestations and imaging findings, a negative contact history, and negative results of a tuberculin skin test (TST) and T-SPOT.TB. Diagnostic bronchoscopy and bronchoalveolar lavage helped make the diagnosis of tuberculosis. Effective treatment was promptly initiated after confirmation of the diagnosis, and the patient's condition improved. This case illustrates that a negative contact history and laboratory results cannot rule out tuberculosis. False-negative TST and T-SPOT.TB results should be evaluated carefully. Bronchoscopy may be useful for identifying pathogens in patients with pneumonia of unknown etiology, and corticosteroids should be administered with caution.
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Affiliation(s)
| | | | | | - Yong Feng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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6
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Taye K, Tolesa N, Tadewos A, Ketema W. Patterns of Childhood Tuberculosis Diagnosis in Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama Regional State, Ethiopia. Pediatric Health Med Ther 2022; 13:349-359. [PMID: 36386042 PMCID: PMC9657258 DOI: 10.2147/phmt.s380092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Because of the pauci bacillary nature of childhood tuberculosis and the difficulties in obtaining proper sputum samples from young children, diagnosing childhood tuberculosis (TB) is difficult. Childhood TB needs early identification and care since it advances swiftly to more advanced stages. This study was aimed to determine the patterns of all forms of childhood tuberculosis diagnosis at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Methods A retrospective cross-sectional study was conducted from February 1, 2017 to January 30, 2021 among 175 children diagnosed and treated for tuberculosis in the pediatric ward. Children medical charts and pediatrics ward logbook were used to extract pertinent data by structured checklists. SPSS version 23.0 was used for data entry and statistical analysis. Results Of 175 children, fever was the leading clinical symptoms and diagnosed in 166 (94.9%) children followed by weight loss (154, 88%), and cough (136, 77.7%). In twenty seven out of 88 (30.6%) children, gastric aspirate was positive for TB infection by Xpert MTB/Rif, while 3/40 (7.5%) were positive for TB using fine needle aspiration cytology (FNAC), 19/66 (28.8%) had suggestive TB by cerebrospinal fluid analysis (CSF), 10/29 (34.5%) were smear positive for TB and 70/162 (43.2%) were suspected for TB by chest X-ray. Conclusion Despite recent breakthroughs in quick microbiological detection, such as Xpert MTB/Rif, this study revealed that more than half of the children, 89/175 (51%), were treated for TB diseases solely based on clinical criteria. This will significantly underestimate the true nature of the illness or disease and make them vulnerable to mistreatment. As a result, in order to appropriately treat the disease and manage patients in our settings, getting a microbiological diagnosis of childhood tuberculosis requires improvement, and we call for expanded availability and use of a more sensitive and specific diagnostic technique to circumvent these concerns.
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Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nagasa Tolesa
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Dembi Dollo University, Dembi Dollo, Ethiopia
| | - Agete Tadewos
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Worku Ketema, Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia, Email
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7
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Smith JP, Song R, McCarthy KD, Mchembere W, Click ES, Cain KP. Clinical and Radiologic Factors Associated With Detection of Mycobacterium tuberculosis in Children Under 5 Years old Using Invasive and Noninvasive Sample Collection Techniques-Kenya. Open Forum Infect Dis 2022; 9:ofac560. [PMID: 36386048 PMCID: PMC9664973 DOI: 10.1093/ofid/ofac560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 10/21/2023] Open
Abstract
Background Pediatric tuberculosis (TB) remains a critical public health concern, yet bacteriologic confirmation of TB in children is challenging. Clinical, demographic, and radiological factors associated with a positive Mycobacterium tuberculosis specimen in young children (≤5 years) are poorly understood. Methods We conducted a prospective cohort study of young children with presumptive TB and examined clinical, demographic, and radiologic factors associated with invasive and noninvasive specimen collection techniques (gastric aspirate, induced sputum, nasopharyngeal aspirate, stool, and string test); up to 2 samples were taken per child, per technique. We estimated associations between these factors and a positive specimen for each technique using generalized estimating equations (GEEs) and logistic regression. Results A median (range) of 544 (507-566) samples were obtained for each specimen collection technique from 300 enrolled children; bacteriologic yield was low across all collection techniques (range, 1%-7% from Xpert MTB/RIF or culture), except for lymph node fine needle aspiration (29%) taken for children with cervical lymphadenopathy. Factors associated with positive M. tuberculosis samples across all techniques included prolonged lethargy (median [range] adjusted odds ratio [aOR], 8.1 [3.9-10.1]), history of exposure with a TB case (median [range] aOR, 6.1 [2.9-9.0]), immunologic evidence of M. tuberculosis infection (median [range] aOR, 4.6 [3.7-9.2]), large airway compression (median [range] aOR, 6.7 [4.7-9.5]), and hilar/mediastinal density (median [range] aOR, 2.9 [1.7-3.2]). Conclusions Identifying factors that lead to a positive M. tuberculosis specimen in very young children can inform clinical management and increase the efficiency of diagnostic testing in children being assessed for TB.
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Affiliation(s)
- Jonathan P Smith
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Kimberly D McCarthy
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Walter Mchembere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor S Click
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin P Cain
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Afrane AKA, Alhassan Y, Ganu V, Adusi-Poku Y, Goka BQ, Kwara A. Childhood tuberculosis and factors associated with mortality and loss to follow-up at a major paediatric treatment centre in Southern Ghana. Pan Afr Med J 2022; 43:90. [PMID: 36605983 PMCID: PMC9805309 DOI: 10.11604/pamj.2022.43.90.35440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction tuberculosis (TB) is a major cause of morbidity and mortality in children in low- and middle-income countries. This study described the clinical presentation and identified factors contributing to poor outcome of childhood TB at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Methods this was a retrospective cohort study of children aged ≤ 14 years with TB registered for treatment at KBTH from 2015 to 2019. Treatment outcomes were recorded as treatment success and unsuccessful outcomes (died and loss to follow-up). Multivariable logistics regression was conducted to assess factors associated with an unsuccessful outcome. Results of 407 children with TB registered during the period, 269 (66.1%) patients had pulmonary tuberculosis (PTB). Of the 138 patients with extra-pulmonary TB (EPTB), 68 (49.3%) had TB lymphadenitis. The TB/HIV coinfection rate was 42.8%. The overall treatment success rate was 68.3%, whilst 71(17.4%) died, and 58 (14.3%) were lost to follow-up. Factors associated with death were age below 1 year (AOR: 3.46, 95% CI: 1.48-8.10, p=0.004) and having HIV coinfection (AOR: 1.89, 95% CI: 1.04-3.43, p=0.037). Factors associated with loss to follow-up were age below 1 year (AOR: 2.91, 95% CI: 1.12-8.59, p=0.029) and having EPTB (AOR: 2.40, 95% CI: 1.24-4.65, p=0.009). Conclusion childhood TB treatment success in our population was below the national target of 85%, with high mortality and loss to follow-up rates, especially in younger children and those with HIV coinfection or EPTB. Tailored treatment strategies may be needed for children at risk of unsuccessful treatment outcome, especially among infants.
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Affiliation(s)
- Adwoa Kumiwa Asare Afrane
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Vincent Ganu
- Infectious Disease Unit, Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Yaw Adusi-Poku
- National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana
| | - Bamenla Quarm Goka
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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9
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Utility and Limits of Lung Ultrasound in Childhood Pulmonary Tuberculosis: Lessons from a Case Series and Literature Review. J Clin Med 2022; 11:jcm11195714. [PMID: 36233582 PMCID: PMC9570535 DOI: 10.3390/jcm11195714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Childhood pulmonary tuberculosis (PTB) diagnosis is often a challenge that requires a combination of history, clinical, radiological, immunological and microbiological findings. Radiological diagnosis is based today on the use of chest X-ray and chest CT that, in addition to being radio-invasive tools for children, are often not available in countries with low-resources. A non-invasive, easily usable and reproducible, low-cost diagnostic tool as LUS would therefore be useful to use to support the diagnosis of childhood PTB. Data on the use of LUS for the diagnosis and follow-up of childhood PTB are limited and in some respects contradictory. To help better define the potential role of LUS we have described the pros and cons of lung ultrasound method through a brief review of the studies in the literature and reporting some case series in which we describe clinical, laboratory, radiological results as well as detailed lung ultrasound findings of four children/adolescents with PTB.
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10
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Gabrovska N, Spasova A, Galacheva A, Kostadinov D, Yanev N, Milanov V, Gabrovski K, Velizarova S. Tuberculosis in Adolescents in Bulgaria for a Three-Year Period: 2018-2020. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060785. [PMID: 35740721 PMCID: PMC9221996 DOI: 10.3390/children9060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background: Each year, approximately two million adolescents and young adults in the world become infected with tuberculosis (TB). The problem is that the classification of the disease includes children in the age group 0−14 years and young adults aged 15 and over. The present study aims to analyze and compare the epidemiology and clinical presentation of TB in Bulgaria in the different age subgroups of childhood. Methods: A retrospective study was undertaken of the newly diagnosed children (n = 80) with TB treated onsite from January 2018 to December 2020 at the Multiprofile Hospital for Active Treatment of Pulmonary Diseases (“St. Sofia”). They were distributed into three age groups: aged 8−11 (prepuberty), aged 12−14 (younger adolescents), and aged above 15 (older adolescents). Results: A clear finding of the research indicated that adolescent children develop TB both as primary and secondary infections. In a large number of cases with the children under our care, we found enlarged intrathoracic lymph nodes as well as infiltrative changes in the lungs, i.e., we observed transitional forms. There were statistically significant differences between the age group >15 years old and each of the other two younger groups for diagnosis, the severity of intoxication, and BK spreading status. Conclusion: The course of tuberculosis in adolescence has its own specifics and differences between the three age groups in the current study.
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Affiliation(s)
- Natalia Gabrovska
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
- Correspondence: ; Tel.: +359-887-931-009
| | - Albena Spasova
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
| | - Anabela Galacheva
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
| | - Dimitar Kostadinov
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Vladimir Milanov
- Department of Pulmonary Diseases, Multiprofile Hospital for Active Treatment of Pulmonary Diseases “St. Sofia”, Medical University–Sofia, 1431 Sofia, Bulgaria; (D.K.); (N.Y.); (V.M.)
| | - Kaloyan Gabrovski
- Department of Neurosurgery, University Hospital “St. Ivan Rilski”, Medical University–Sofia, 1431 Sofia, Bulgaria;
| | - Svetlana Velizarova
- Department of Pediatrics, Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Ivan Mitev”, Medical University–Sofia, 1606 Sofia, Bulgaria; (A.S.); (A.G.); (S.V.)
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11
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Lozano-Acosta MM, Rubiano-Arenas MA, Cadavid LM, Vélez-Parra G, Molinares B, Marín-Pineda DM, Arbeláez-Montoya MP, Benjumea-Bedoya D. Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis. BMC Pediatr 2022; 22:307. [PMID: 35610599 PMCID: PMC9131565 DOI: 10.1186/s12887-022-03347-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. METHODS Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. RESULTS From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). CONCLUSIONS Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.
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Affiliation(s)
- María Margarita Lozano-Acosta
- Grupo de Investigación en Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Calle 51 # 51-27, Medellín, Colombia
| | - María Alejandra Rubiano-Arenas
- Grupo de Investigación en Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Calle 51 # 51-27, Medellín, Colombia
| | | | | | | | | | | | - Dione Benjumea-Bedoya
- Grupo de Investigación en Salud Familiar y Comunitaria, Facultad de Ciencias de la Salud, Corporación Universitaria Remington, Calle 51 # 51-27, Medellín, Colombia
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Bacteriología y Micobacterias, Corporación Para Investigaciones Biológicas-CIB, Medellín, Colombia
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12
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Poh XY, Loh FK, Friedland JS, Ong CWM. Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System - Tuberculosis. Front Immunol 2022; 12:788976. [PMID: 35095865 PMCID: PMC8789671 DOI: 10.3389/fimmu.2021.788976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
Tuberculosis (TB) remains one of the leading infectious killers in the world, infecting approximately a quarter of the world’s population with the causative organism Mycobacterium tuberculosis (M. tb). Central nervous system tuberculosis (CNS-TB) is the most severe form of TB, with high mortality and residual neurological sequelae even with effective TB treatment. In CNS-TB, recruited neutrophils infiltrate into the brain to carry out its antimicrobial functions of degranulation, phagocytosis and NETosis. However, neutrophils also mediate inflammation, tissue destruction and immunopathology in the CNS. Neutrophils release key mediators including matrix metalloproteinase (MMPs) which degrade brain extracellular matrix (ECM), tumor necrosis factor (TNF)-α which may drive inflammation, reactive oxygen species (ROS) that drive cellular necrosis and neutrophil extracellular traps (NETs), interacting with platelets to form thrombi that may lead to ischemic stroke. Host-directed therapies (HDTs) targeting these key mediators are potentially exciting, but currently remain of unproven effectiveness. This article reviews the key role of neutrophils and neutrophil-derived mediators in driving CNS-TB immunopathology.
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Affiliation(s)
- Xuan Ying Poh
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fei Kean Loh
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jon S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Catherine W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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13
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Moscibrodzki P, Enane LA, Hoddinott G, Brooks MB, Byron V, Furin J, Seddon JA, Meyersohn L, Chiang SS. The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults. Pathogens 2021; 10:1591. [PMID: 34959546 PMCID: PMC8706072 DOI: 10.3390/pathogens10121591] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/26/2023] Open
Abstract
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being.
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Affiliation(s)
- Patricia Moscibrodzki
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Virginia Byron
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.B.B.); (V.B.); (J.F.)
- Sentinel Project on Pediatric Drug-Resistant Tuberculosis, Boston, MA 02115, USA
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 8000, South Africa; (G.H.); (J.A.S.)
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Lily Meyersohn
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
| | - Silvia S. Chiang
- Center for International Health Research, Rhode Island Hospital, Providence, RI 02903, USA; (L.M.); (S.S.C.)
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
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14
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Tersigni C, Boiardi G, Tofani L, Venturini E, Montagnani C, Bortone B, Bianchi L, Chiappini E, Cassetta MI, Fallani S, Novelli A, Galli L. Real-life isoniazid and rifampicin plasma concentrations in children: a tool for therapeutic drug monitoring of tuberculosis. BMC Infect Dis 2021; 21:1087. [PMID: 34674665 PMCID: PMC8529739 DOI: 10.1186/s12879-021-06764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Low plasma levels of first-line antitubercular drugs can be counted among the main causes of poor response to antitubercular therapy, and therapeutic drug monitoring has been proposed as a method to promote tailored treatments for both child and adult patients. The main aim of the study was to evaluate serum concentrations of isoniazid (INH) and rifampicin (RIF) and to investigate reasons for sub-therapeutic plasma concentrations in order to fix dosages. Methods Children with TB were prospectively enrolled from January to August 2019. Two venous blood samples were collected (the first at least 15 days after the beginning of antitubercular treatment, and the second between 1 and 8 weeks later). Plasma concentrations were determined by a validated high-performance liquid chromatography method. Results In all, 45 children were included. Seventy blood samples for INH plasma concentration were collected between 120 and 240 min after drug intake. Adjusting for dose (mg/kg/day) and time of INH administration, when considering three different age groups (≤ 2 years, 2–12 years, > 12 years), a statistically significant lower INH plasma concentration was observed in younger children compared to the older age groups in the multivariate analysis (p < 0.001 and p < 0.001). A total of 68 blood samples were evaluated for RIF concentrations. Both for INH and RIF a statistically significant lower plasma concentration was also observed in adolescents (p < 0.001). Fifteen children (15/45, 33%) presented drug concentrations under the referral therapeutic range. Conclusions Based on our findings, monitoring patients’ drug plasma concentrations in children under 2 years of age and in adolescents can make treatment more patient-tailored.
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Affiliation(s)
- Chiara Tersigni
- Post Graduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Lorenzo Tofani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Iris Cassetta
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Stefania Fallani
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy. .,Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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15
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Comparison of clinical and laboratory profile of pulmonary and extrapulmonary tuberculosis in children: A single-center experience from India. J Clin Transl Res 2021; 7:423-427. [PMID: 34667887 PMCID: PMC8520702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Pediatric tuberculosis (TB) is an indicator of the recent transmission of TB in the community. However, the diagnosis of pediatric TB poses a challenge to clinicians. AIMS We aimed to evaluate and compare the clinical and laboratory profile of pulmonary TB (PTB) and extra PTB (EPTB) in children and adolescents. METHODS In this retrospective observational study, children attending the pediatric TB clinic of All India Institute of Medical Sciences, Rishikesh, from August 2015 to July 2017 were included in the study. The medical case records of patients were reviewed for demography, clinical findings, investigations, and diagnosis. The clinical and laboratory characteristics of patients with PTB and EPTB were compared. RESULTS A total of 58 children included. Out of which, 33 (56.9%) had PTB, and 25 (43.1%) had EPTB. The EPTB cases included 15 (60%) pleural TB, 9 (36%) lymph node TB, and 1 (4%) TB meningitis patient. Fever, cough, and weight loss were the most common symptoms. Hilar lymphadenopathy was the most common radiological abnormality. Microbiological confirmation was possible in 54.5% of patients with PTB. Cough (aOR 70.326; 95% CI: 5.370-921.032) and microbiological confirmation (aOR 46.011; 95% CI: 2.073-1021.201) were more in PTB as compared to EPTB. CONCLUSIONS PTB and EPTB are common in children and adolescents. The typical clinical manifestations and positive microbiological confirmation are less common in EPTB than PTB. RELEVANCE FOR PATIENTS TB is one of the common communicable diseases in the developing world. Diagnosis of TB in children is often challenging. Our study results help in better understanding childhood TB and EPTB clinical features and have potential to increase diagnostic yield.
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Lamb GS, Cruz AT, Camp EA, Javier M, Montour J, Piper T, Shah UA, Starke JR. Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010-2015 1. Emerg Infect Dis 2021; 26. [PMID: 32687465 PMCID: PMC7392435 DOI: 10.3201/eid2608.190793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
US guidelines have recommended testing children emigrating from high tuberculosis-incidence countries with interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs). We describe the Harris County (Texas) Public Health Refugee Health Screening Program's testing results during 2010-2015 for children <18 years of age: 5,990 were evaluated, and 5,870 (98%) were tested. Overall, 364 (6.2%) children had >1 positive test: 143/1,842 (7.8%) were tested with TST alone, 129/3,730 (3.5%) with IGRA alone, and 92/298 (30.9%) with both TST and IGRA. Region of origin and younger age were associated with positive TST or IGRA results. All children were more likely to have positive results for TST than for IGRA (OR 2.92, 95% CI 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%), likely because of bacillus Calmette-Guérin vaccination. Finding fewer false positives supports the 2018 change in US immigration guidelines that recommends using IGRAs for recently immigrated children.
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Asemahagn MA. Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study. BMC Pulm Med 2021; 21:118. [PMID: 33832466 PMCID: PMC8033743 DOI: 10.1186/s12890-021-01483-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sputum smear conversion is a key indicator of treatment response and reduced infectivity among bacteriologically confirmed pulmonary tuberculosis (PTB) patients. This study aimed at estimating sputum smear conversion and identifying factors hindering sputum smear conversion among bacteriologically confirmed PTB cases in East Gojjam Zone, Northwest Ethiopia. METHODS A total of 282 bacteriologically confirmed PTB patients were followed for 22 weeks through weekly sputum smear examination. Due to the absence of sputum culture and rapid diagnostic services, sputum smear conversion evaluation was conducted microscopically using acid-fast-bacilli staining technique of sediments from a 5% sodium hypochlorite concentration technique. Data on socio-demographic, clinical profile and personal behavior variables were collected using a pretested interviewer-administered questionnaire. Various descriptive statistics including mean, median with interquartile range (IQR), and proportions were computed to describe study objectives. Factors of sputum smear conversion were identified by multivariable logistic regression analysis and statistical significance was determined at a p value < 0.05. RESULTS Over half, 166 (59%) of bacteriologically confirmed PTB patients were males and 147 (52%) were rural dwellers. The mean age of respondents was 35 ± 5 SD years. About 88 (31.2%) of bacteriologically confirmed PTB patients had comorbidities, 102 (36.2%) faced stigma, and 54 (19%) history of cigarette smoking. The median sputum smear conversions during the intensive phase and 5th months of treatment follow up were 35 dyas (IQR: 21-56 days) and 53 days (IQR: 28-82 days), respectuvely. The majority, 85% (95% CI 76-93%) and 95% (95% CI 85-99%) of bacteriologically confirmed PTB patients underwent sputum smear conversion at the end of 2nd and 5th months of treatment, respectively. Poor knowledge on TB, being HIV positive, higher smear grading, having diabetes mellitus, undernutrition, cigarette smoking, facing societal stigma, and TB service delays were positively associated with the length of sputum smear conversion (p value < 0.05). CONCLUSION Based on this study, the median sputum smear conversion time was higher compared to TB program expectations and findings from former studies. The study also identified important factors associated with sputum smear conversion time. Improving health literacy of the community by revising the existing community awareness strategies is essential to enhance treatment adherence and lower infectiousness after treatment initiation.
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Affiliation(s)
- Mulusew Andualem Asemahagn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Taye H, Alemu K, Mihret A, Wood JL, Shkedy Z, Berg S, Aseffa A. Factors associated with localization of tuberculosis disease among patients in a high burden country: A health facility-based comparative study in Ethiopia. J Clin Tuberc Other Mycobact Dis 2021; 23:100231. [PMID: 33851036 PMCID: PMC8039820 DOI: 10.1016/j.jctube.2021.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A steady high rate of cervical tuberculous lymphadenitis (TBLN) has been reported in Ethiopia. That was significantly associated with biological factors that include age and sex of individuals. The risk of developing TBLN also related with chronic medical conditions such as renal disease. Suggests that specific symptom based screening may lead to missing a significant portion of cases. Hence, lymph node enlargement should be considered in the national case screening program.
Introduction In contrast to most tuberculosis (TB) high burden countries, Ethiopia has for a long time reported a very high percentage of extra pulmonary TB (EPTB), which is also reflected in population based estimations reported by the World Health Organization (WHO). Particularly a steadily higher proportion of cervical tuberculous lymphadenitis (TBLN) has been described. Here we identify clinical and demographic factors associated with anatomic site of the TB disease. Method A health facility based comparative study was conducted among TBLN and PTB patients who visited selected health facilities in Ethiopia during 2016 and 2017. Associated risk factors were identified through a multivariate logistic regression model using R-studio. Result A total of 1,890 study participants, 427 TBLN and 1,463 PTB patients, were included. The mean age of TBLN patients (29 years ± 14.4 SD) was lower than that of PTB cases (36 years ± 15.0 SD). There were slightly more women diagnosed with TBLN (51.1%) while nearly 6 out of 10 male patients were diagnosed with PTB (58.9%). Most significantly, younger age groups (<15 Years) were more likely to develop cervical TBLN than older people (>56 years), with an AOR of 9.76 (95% CI: 4.87, 19.56). The odds of cervical TBLN among women [1.69 (1.30, 2.20)] was higher than that for men. In addition, adjusted estimates suggested that, compared with PTB, renal diseases [3.41 (1.29, 9.02)] and the presence of other concomitant chronic illness [1.61 (1.23, 2.09)] had a significant association with TBLN. Conclusion Generally, the risk of developing a particular form of TB disease is usually associated with demographic and medical history of an infected individual. Hence, the current symptom based screening, which primarily rely on chronic cough in many countries, may lead to missing significant portions of TBLN cases.
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Affiliation(s)
- Hawult Taye
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Corresponding author at: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - James L.N. Wood
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Ziv Shkedy
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Biostatistics and Bioinformatics, University of Hasselt, Belgium
| | - Stefan Berg
- Bacteriology Department, Animal and Plant Health Agency, Weybridge, UK
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Necho M, Tsehay M, Seid M, Zenebe Y, Belete A, Gelaye H, Muche A. Prevalence and associated factors for alcohol use disorder among tuberculosis patients: a systematic review and meta-analysis study. Subst Abuse Treat Prev Policy 2021; 16:2. [PMID: 33388060 PMCID: PMC7778806 DOI: 10.1186/s13011-020-00335-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) in tuberculosis patients are complicated with poor compliance to anti-tuberculosis treatment and poor tuberculosis treatment outcomes. However, aggregate data concerning this problem is not available. Therefore, this review aimed to fill the above gap by generating an average prevalence of AUD in tuberculosis patients. METHOD Our electronic search for original articles was conducted in the databases of Scopus, PubMed, and EMBASE, African Index Medicus, and psych-info. Besides, the reference list of selected articles was looked at manually to have further eligible articles for the prevalence and associated factors of AUD in tuberculosis patients. The random-effects model was employed during the analysis. MS-Excel was used to extract data and stata-11 to determine the average prevalence of AUD among tuberculosis patients. A sub-group analysis and sensitivity analysis were also run. A visual inspection of the funnel plots and an Eggers publication bias plot test were checked for the presence of publication bias. RESULT A search of the electronic and manual system resulted in 1970 articles. After removing duplicates and unoriginal articles, only 28 articles that studied 30,854 tuberculosis patients met the inclusion criteria. The average estimated prevalence of AUD in tuberculosis patients was 30% (95% CI: 24.00, 35.00). This was with a slight heterogeneity (I2 = 57%, p-value < 0.001). The prevalence of AUD in tuberculosis patients was higher in Asia and Europe; 37% than the prevalence in the US and Africa; 24%. Besides, the average prevalence of AUD was 39, 30, 30, and 20% in studies with case-control, cohort, cross-sectional and experimental in design respectively. Also, the prevalence of AUD was higher in studies with the assessment tool not reported (36%) than studies assessed with AUDIT. AUD was also relatively higher in studies with a mean age of ≥40 years (42%) than studies with a mean age < 40 years (24%) and mean age not reported (27%). Based on a qualitative review; the male gender, older age, being single, unemployment, low level of education and income from socio-demographic variables, retreatment and treatment failure patients, stigma, and medication non-adherence from clinical variables were among the associated factors for AUD. CONCLUSION This review obtained a high average prevalence of AUD in tuberculosis patients and this varies across continents, design of studies, mean age of the participants, and assessment tool used. This implied the need for early screening and management of AUD in tuberculosis patients.
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Affiliation(s)
- Mogesie Necho
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Mekonnen Tsehay
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Muhammed Seid
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Asmare Belete
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Habitam Gelaye
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- College of Medicine and Health Sciences, Department of Public Health, Wollo University, Dessie, Ethiopia
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20
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Xiao X, Li Q, Ju Y. Giant central nervous system tuberculoma in pediatric patients: surgical case series. Childs Nerv Syst 2021; 37:2935-2941. [PMID: 33675392 PMCID: PMC8423696 DOI: 10.1007/s00381-021-05091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Central nervous system tuberculoma is rare and challenging situation. Clinical records of patients with pathologically proven tuberculoma were retrospectively reviewed. Clinical presentation, lesion location, radiological characteristics, perioperative and surgical management, and outcome is summarized and analyzed. Eight patients were included and there was one girl. Age ranged from 3 to 14 years with mean age 9.8 years. Clinical duration ranged from 20 days to 2 years, and 3 patients had previous lung tuberculosis with anti-TB treatment. The lesion was in cerebellum in 6 cases, including 1 involving basal ganglia and 1 involving thalamus. The lesion was in basal ganglia, thalamus, and third ventricle in 1 case, and in T12-L1 spinal cord in another. Cerebellar lesion was resected via paramedian suboccipital approach in 5 patients, basal ganglia lesion via trans-cortical frontal horn approach in 2 patients, and intra-spinal lesion via trans-laminar approach in 1 patient. Follow-up ranged from 10 to 24 months. Of the 8 patients, 6 returned to normal life. One patient had cerebellar lesion resected and the thalamic lesion reduced in size after anti-TB treatment. One patient died from TB spreading. Our data showed that most patients can be successfully treated by resection of the lesion. Low T2 signal, ring shaped enhancement and peripheral edema strongly suggest tuberculoma. Empirical anti-TB treatment should be initiated perioperatively.
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Affiliation(s)
- Xiao Xiao
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Qiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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21
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Awaluddin SM, Ismail N, Zakaria Y, Yasin SM, Razali A, Mutalip MHA, Lodz NA, Musa KI, Kusnin F, Aris T. Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years. BMC Public Health 2020; 20:1903. [PMID: 33302908 PMCID: PMC7731774 DOI: 10.1186/s12889-020-10005-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia. Methods Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants. Results In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children. Conclusions The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.
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Affiliation(s)
- S Maria Awaluddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.,Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Nurhuda Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
| | - Yuslina Zakaria
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Siti Munira Yasin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Asmah Razali
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Hatta Abdul Mutalip
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Noor Aliza Lodz
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Faridah Kusnin
- Selangor Health State Department, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Tahir Aris
- Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
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22
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Català M, Prats C, López D, Cardona PJ, Alonso S. A reaction-diffusion model to understand granulomas formation inside secondary lobule during tuberculosis infection. PLoS One 2020; 15:e0239289. [PMID: 32936814 PMCID: PMC7494083 DOI: 10.1371/journal.pone.0239289] [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: 05/12/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
Mycobacterium tuberculosis (Mtb) is the causative agent for tuberculosis, the most extended infectious disease around the world. When Mtb enters inside the pulmonary alveolus it is rapidly phagocytosed by the alveolar macrophage. Although this controls the majority of inhaled microorganisms, in this case, Mtb survives inside the macrophage and multiplies. A posterior chemokine and cytokine cascade generated by the irruption of monocytes, neutrophils and posteriorly, by T-cells, does not necessarily stop the growth of the granuloma. Interestingly, the encapsulation process built by fibroblasts is able to surround the lesion and stop its growing. The success of this last process determines if the host enters in an asymptomatic latent state or continues into a life-threatening and infective active tuberculosis disease (TB). Understanding such dichotomic process is challenging, and computational modeling can bring new ideas. Thus, we have modeled the different stages of the infection, first in a single alveolus (a sac with a radius of 0.15 millimeters) and, second, inside a secondary lobule (a compartment of the lungs of around 3 cm3). We have employed stochastic reaction-diffusion equations to model the interactions among the cells and the diffusive transport to neighboring alveolus. The whole set of equations have successfully described the encapsulation process and determine that the size of the lesions depends on its position on the secondary lobule. We conclude that size and shape of the secondary lobule are the relevant variables to control the lesions, and, therefore, to avoid the evolution towards TB development. As lesions appear near to interlobular connective tissue they are easily controlled and their growth is drastically stopped, in this sense secondary lobules with a more flattened shape could control better the lesion.
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Affiliation(s)
- Martí Català
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol. Badalona, Catalonia, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol. Badalona, Catalonia, Spain
- * E-mail:
| | - Daniel López
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Pere-Joan Cardona
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol. Badalona, Catalonia, Spain
- Experimental Tuberculosis Unit (UTE), Fundació Institut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona (UAB), Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Sergio Alonso
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
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Xie Y, McNeil E, Fan Y, Chongsuvivatwong V, Zhao X, Sriplung H. Quality of Respiratory Infection Disease Prevention in Outpatient and Emergency Departments in Hospitals in Inner Mongolia, China: An Exit Poll Survey. Risk Manag Healthc Policy 2020; 13:501-508. [PMID: 32581612 PMCID: PMC7276319 DOI: 10.2147/rmhp.s248772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Measures to prevent respiratory infection diseases (RIDs) in hospitals are important to protect both patients and physicians. In 2003, an outbreak of severe acute respiratory syndrome occurred in Inner Mongolia Autonomous Region (IMAR) of China. We aimed to evaluate competency in RID prevention procedures in terms of hospital performance and physician behavior. Patients and Methods We conducted a cross-sectional study in 10 tertiary general public hospitals in 3 cities of IMAR. In each hospital, we chose the respiratory and ear–nose–throat outpatient departments (OPDs) and the emergency department (ED) to invite patients with symptoms of cough to join the study before they consulted a physician. After their consultation, we asked the patients to complete a checklist to score the performance of the departments and the behavior of their physicians in terms of RID prevention practices according to international professional guidelines. Results From 711 respondents, in the domain of hospital performance, display of posters on directive to wash hands after coughing/sneezing had an average score of 0.452 (range 0–1), while other cough etiquette items had scores averaging between 0.33 and 0.39. The average score for air ventilation was 0.66. For physicians’ performance, informing patients the location of handwashing facilities scored the highest (0.62), while low scores were seen for offering a mask to coughing patients (0.14) and encouraging coughing patients to distance themselves from others (0.17). Most RID prevention procedures received low scores in EDs in both hospital performance and physician behavior domains. Conclusion Hospitals in IMAR should improve their performance in RID prevention procedures, especially in giving information to RID patients through the display of posters. The practice of physicians in preventing respiratory infection spread was suboptimum. ED staff and hospital administrators should improve their procedures to prevent the spread of respiratory infections, especially given the increasing occurrences of global pandemics such as COVID-19.
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Affiliation(s)
- Yijing Xie
- Health Management Faculty and Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China.,Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yancun Fan
- Health Management Faculty and Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | | | - Xingsheng Zhao
- Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, People's Republic of China
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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24
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Denoeud-Ndam L, Otieno-Masaba R, Tchounga B, Machekano R, Simo L, Mboya JP, Kose J, Tchendjou P, Bissek ACZK, Okomo GO, Casenghi M, Cohn J, Tiam A. Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial. BMC Public Health 2020; 20:623. [PMID: 32375741 PMCID: PMC7201651 DOI: 10.1186/s12889-020-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. Methods Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. Discussion Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services. Trial resistration NCT03862261, initial release 12 February 2019.
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Affiliation(s)
| | | | | | | | | | | | - Judith Kose
- EGPAF, Nairobi, Kenya.,Erasmus University Medical Centre, Rotterdam, the Netherlands
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25
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Davis AG, Nightingale S, Springer PE, Solomons R, Arenivas A, Wilkinson RJ, Anderson ST, Chow FC. Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis. Wellcome Open Res 2019; 4:178. [PMID: 31984243 PMCID: PMC6971841 DOI: 10.12688/wellcomeopenres.15516.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.
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Affiliation(s)
- Angharad G Davis
- University College London, Gower Street, London, WC1E 6BT, UK.,Francis Crick Institute, Midland Road, London, NW1 1AT, UK.,Institute of Infectious Diseases and Molecular Medicine. Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, University of Cape Town,, Observatory, 7925, South Africa
| | - Priscilla E Springer
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ana Arenivas
- The Institute for Rehabilitation and Research Memorial Hermann, Department of Rehabilitation Psychology and Neuropsychology,, Houston, Texas, USA.,Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA
| | - Robert J Wilkinson
- Francis Crick Institute, Midland Road, London, NW1 1AT, UK.,Department of Infectious Diseases, Imperial College London, London, W2 1PG, UK.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine at Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Suzanne T Anderson
- MRC Clinical Trials Unit at UCL, University College London, London, WC1E 6BT, UK.,Evelina Community, Guys and St Thomas' NHS Trust, 5 Dugard Way, London, SE11 4TH, UK
| | - Felicia C Chow
- Weill Institute of Neurosciences, Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, USA
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Mirutse G, Fang M, Kahsay AB, Ma X. Epidemiology of childhood tuberculosis and factors associated with unsuccessful treatment outcomes in Tigray, Ethiopia: a ten-year retrospective cross sectional study. BMC Public Health 2019; 19:1367. [PMID: 31651319 PMCID: PMC6814041 DOI: 10.1186/s12889-019-7732-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood TB is an indicator of a recent transmission of the disease in a community and it is estimated to constitute 15-20% of all TB cases in many of developing countries. However, only few studies which dominated by industrial countries were engaged to assess the situation. Therefore, this study was aimed to see epidemiology of childhood TB and factors associated with poor treatment outcome in developing country. METHOD Using retrospective cross-sectional study design; Socio-demographic and clinical data of children aged less than 15 years old, treated for all forms of TB in the past 10 years (2007-2016) was collected from randomly selected eight public hospitals of Tigray. Then, Univariate logistic regression and adjusted multivariate logistic regressions was done to identify variables which had association with unsuccessful treatment outcomes at P-value less than 0.05. RESULT In the past 10 years, a total of 13,345 Tuberculosis cases were observed. Of these, 1086 (8.1%) cases were children aged less than 15 years old. Sixty seven (6.2%) cases were smear positive. Among those that tested for HIV, 69 (8.3%) cases were TB/HIV co-infected. Of those with treatment outcome record 746 (88.7%) were successfully treated. Factors like being female (AOR, 1.79; 95% CI, 1.07-3.00), Age 0-5 years (AOR, 3.35; 95% CI, 2.11-5.33), Unknown HIV status (AOR, 2.44; 95% CI, 1.51-3.95) and pulmonary positive case (AOR, 2.56; 95% CI, 1.13-5.77), were more likely to have unsuccessful treatment outcome than their counterparts. CONCLUSION In Tigray 8.1% all TB cases were children age less than 15 years old. Childhood TB treatment outcome varied with sex, age and HIV status.
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Affiliation(s)
- Gebremeskel Mirutse
- School of Public Health, College of Health Science, Mekelle University, Mekelle, Tigray Ethiopia
| | - Mingwang Fang
- Department of Health-Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, 610041 China
| | - Alemayehu Bayray Kahsay
- School of Public Health, College of Health Science, Mekelle University, Mekelle, Tigray Ethiopia
| | - Xiao Ma
- Department of Health-Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, 610041 China
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Hamid M, Brooks MB, Madhani F, Ali H, Naseer MJ, Becerra M, Amanullah F. Risk factors for unsuccessful tuberculosis treatment outcomes in children. PLoS One 2019; 14:e0222776. [PMID: 31553758 PMCID: PMC6760830 DOI: 10.1371/journal.pone.0222776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pakistan has a high pediatric burden of tuberculosis, but few studies describe the treatment experience of children with tuberculosis in Pakistan. We sought to identify risk factors for unsuccessful treatment outcomes in children with drug-susceptible tuberculosis identified in eight hospitals in Karachi, Pakistan. DESIGN We conducted a retrospective cohort study among children (<15 years old) treated with first-line anti-tuberculosis drugs for presumed or confirmed drug-susceptible tuberculosis between 2016 and 2017. We assessed risk factors for experiencing an unsuccessful treatment outcome through multivariable logistic regression analysis. RESULTS In total, 1,665 children initiated tuberculosis treatment, including 916 (55.0%) identified through intensified case finding. Unsuccessful treatment outcomes were experienced by 197 (11.8%) children, comprising 27 (1.6%) deaths, 16 (1.0%) treatment failures, and 154 (9.3%) lost to follow-up. An additional 47 (2.8%) children had outcomes not evaluable. In multivariable analysis, children 0-4 years old (OR: 1.80, 95% CI: 1.07-3.04), males (OR: 1.48, 95% CI: 1.04, 2.11), and those with bacteriologic confirmation of disease (OR: 3.39, 95% CI: 1.98, 5.80) had increased odds of experiencing an unsuccessful treatment outcome. CONCLUSION Our findings suggest a need to deploy strategies to identify children earlier in the disease process and point to the need for interventions tailored for young children once treatment is initiated.
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Affiliation(s)
- Meherunissa Hamid
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
- * E-mail:
| | - Meredith B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Falak Madhani
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
| | - Hassan Ali
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
| | | | | | - Mercedes Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Farhana Amanullah
- Global Health Directorate, The Indus Health Network, Karachi, Sindh, Pakistan
- Department of Pediatrics, The Indus Hospital, Karachi, Sindh, Pakistan
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Oliwa JN, Gathara D, Ogero M, van Hensbroek MB, English M, van’t Hoog A. Diagnostic practices and estimated burden of tuberculosis among children admitted to 13 government hospitals in Kenya: An analysis of two years' routine clinical data. PLoS One 2019; 14:e0221145. [PMID: 31483793 PMCID: PMC6726144 DOI: 10.1371/journal.pone.0221145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND True burden of tuberculosis (TB) in children is unknown. Hospitalised children are low-hanging fruit for TB case detection as they are within the system. We aimed to explore the process of recognition and investigation for childhood TB using a guideline-linked cascade of care. METHODS This was an observational study of 42,107 children admitted to 13 county hospitals in Kenya from 01Nov 15-31Oct 16, and 01Nov 17-31Oct 18. We estimated those that met each step of the cascade, those with an apparent (or "Working") TB diagnosis and modelled associations with TB tests amongst guideline-eligible children. RESULTS 23,741/42,107 (56.4%) met step 1 of the cascade (≥2 signs and symptoms suggestive of TB). Step 2(further screening of history of TB contact/full respiratory exam) was documented in 14,873/23,741 (62.6%) who met Step 1. Step 3(chest x-ray or Mantoux test) was requested in 2,451/14,873 (16.5%) who met Step 2. Step 4(≥1 bacteriological test) was requested in 392/2,451 (15.9%) who met Step 3. Step 5("Working TB" diagnosis) was documented in 175/392 (44.6%) who met Step 4. Factors associated with request of TB tests in patients who met Step 1 included: i) older children [AOR 1.19(CI 1.09-1.31)]; ii) co-morbidities of HIV, malnutrition or pneumonia [AOR 3.81(CI 3.05-4.75), 2.98(CI 2.69-3.31) and 2.98(CI 2.60-3.40) respectively]; iii) sicker children, readmitted/referred [AOR 1.24(CI 1.08-1.42) and 1.15(CI 1.04-1.28) respectively]. "Working TB" diagnosis was made in 2.9%(1,202/42,107) of all admissions and 0.2%(89/42,107) were bacteriologically-confirmed. CONCLUSIONS More than half of all paediatric admissions had symptoms associated with TB and nearly two-thirds had more specific history documented. Only a few amongst them got TB tests requested. TB was diagnosed in 2.9% of all admissions but most were inadequately investigated. Major challenges remain in identifying and investigating TB in children in hospitals with access to Xpert MTB/RIF and a review is needed of existing guidelines.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- University of Nairobi, Department of Paediatrics and Child Health, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Morris Ogero
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
| | - Michaël Boele van Hensbroek
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Health Services Research Group, Nairobi, Kenya
- Oxford University, Nuffield Department of Medicine, Oxford, England, United Kingdom
| | - Anja van’t Hoog
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- The Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
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Ohene SA, Fordah S, Dela Boni P. Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis. BMC Infect Dis 2019; 19:749. [PMID: 31455234 PMCID: PMC6712824 DOI: 10.1186/s12879-019-4392-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/19/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana. METHODS A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality. RESULTS Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality. CONCLUSION The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.
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Affiliation(s)
| | | | - Prince Dela Boni
- Ghana Institute of Management and Public Administration, Accra, Ghana
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30
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Ramos JM, Pérez-Butragueño M, Tesfamariam A, Reyes F, Tiziano G, Endirays J, Balcha S, Elala T, Biru D, Comeche B, Górgolas M. Comparing tuberculosis in children aged under 5 versus 5 to 14 years old in a rural hospital in southern Ethiopia: an 18-year retrospective cross-sectional study. BMC Public Health 2019; 19:856. [PMID: 31266471 PMCID: PMC6604275 DOI: 10.1186/s12889-019-7206-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background There are few data available about childhood tuberculosis (TB) in rural hospitals in low-income countries. We assessed differences in epidemiological characteristics and treatment outcomes in children with TB aged 0–4 versus 5–14 years in rural Ethiopia. Methods For this retrospective cross-sectional study, we analyzed childhood TB registers from a rural Ethiopian hospital. We collected data on the number of cases, type of TB, and treatment outcomes using standard definitions. By means of binary and logistic regression analyses, data were compared from 1998 to 2015 in children aged under 5 versus those aged 5–14 years. Results We included 1282 TB patients: 583 (45.5%) were under 5 years old, and 699 (54.5%) were aged 5–14 years. More than half (67.2%, n = 862) had pulmonary TB (PTB), which was more common in younger children (82.5%, 481/583) than in older ones (54.5%, 381/699; p < 0.001). Most cases of PTB (87.5%, 754/862) were smear negative, including virtually all (99.6%, 479/481) younger children and most older ones (72.2%, n = 275/381; p < 0.001). The most common types of extrapulmonary TB (EPTB) were TB adenitis (54.5%, 229/420) and bone TB (20%, 84/420). Children under five showed a lower prevalence of adenitis TB (9.9% [58/583] versus 24.5% [171/699], p < 0.001), bone TB (2.9% [17/583] versus 9.6% [69/699], p < 0.001), and abdominal TB (0.9% [5/583] versus 6.3% [44/699], p < 0.001). Most diagnoses were new cases of TB (98.2%, 1259/1282). Overall, 63.5% (n = 814) of the children successfully completed treatment (< 5 years: 56.6%, 330/583; 5–14 years: 69.2%, 489/699; p < 0.001). In total, 16.3% (n = 209) transferred to another center (< 5 years: 19.4%, 113/583; 5–14 years: 13.7%, 96/699; p = 0.006). Thirteen percent of patients (n = 167) were lost to follow-up (< 5 years: 16.0%, 93/583; 5–14 years: 10.4%, 74/699; p = 0.004). Fifty-two (4.1%) children died (no age differences). Being aged 5–14 years was independently associated with successful treatment outcomes (adjusted odds ratio 1.59; 95% confidence interval: 1.16, 1.94, p = 0.002). Conclusions We observed a very low diagnostic yield for spontaneous sputum smear in children with TB. In this rural setting in Ethiopia, very young children tend to present with new cases of smear-negative PTB. They have less EPTB than older children but more TB meningitis and show lower rates of treatment success. Electronic supplementary material The online version of this article (10.1186/s12889-019-7206-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- José M Ramos
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia. .,Department of Internal Medicine, Alicante General University Hospital, ISABIAL, Calle Pintor Baeza, 12, 03010, Alicante, Spain. .,Miguel Hernández University of Elche, Alicante, Spain.
| | - Mario Pérez-Butragueño
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,Department of Pediatrics, Infanta Leonor University Hospital, Madrid, Spain
| | - Abraham Tesfamariam
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Francisco Reyes
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Gebre Tiziano
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Jacob Endirays
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Seble Balcha
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Tamasghen Elala
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Dejene Biru
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia
| | - Belén Comeche
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,National Referral Unit for Tropical Disease, Infectious Diseases Department, Ramón y Cajal University Hospital, IRICYS, Madrid, Spain
| | - Miguel Górgolas
- Department of Medicine and Pediatrics, Gambo Rural General Hospital, Shashamane, Ethiopia.,Division of Infectious Diseases, Jiménez Diaz University Hospital Foundation, and Autonomic University of Madrid, Madrid, Spain
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Beshir MT, Beyene AH, Tlaye KG, Demelew TM. Incidence and predictors of tuberculosis among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia: a retrospective follow-up study. Epidemiol Health 2019; 41:e2019028. [PMID: 31319659 PMCID: PMC6702120 DOI: 10.4178/epih.e2019028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/22/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Tuberculosis (TB) is common in children with human immunodeficiency virus (HIV), but its effect on the survival of HIV-infected children is not well understood. Therefore, the aim of this study was to assess the incidence and predictors of active TB among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia. METHODS A retrospective study was conducted over 5 years using a checklist to gather data from 428 randomly selected pediatric patient charts. The checklist was adapted from the standardized antiretroviral therapy (ART) follow-up form currently used by the institution's ART clinic. Data were analyzed by bivariate and multivariable analysis using Cox regression proportional hazards models, as appropriate. Survival was calculated and compared using the Kaplan-Meier and log-rank tests. RESULTS Of the 466 charts reviewed, 428 patient records were included in the analysis. A total of 67 new TB cases were observed during the follow-up period. Hence, the incidence rate in this cohort was found to be 6.03 per 100 child-years of observation. A baseline hemoglobin level <10 g/dL (adjusted hazard ratio [aHR], 7.04; 95% confidence interval [CI], 1.03 to 48.15), moderate wasting (aHR, 2.86; 95% CI, 1.02 to 7.99), and not receiving isoniazid preventive therapy (aHR, 8.23; 95% CI, 2.11 to 32.06) were among the independent predictors of TB occurrence. CONCLUSIONS The incidence of TB was high, particularly in pre-ART patients receiving chronic care for HIV. Close followup of HIV-positive children is crucial to protect them against the development of TB. Initiating isoniazid preventive therapy, averting malnutrition, and managing anemia are also of significant importance.
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Affiliation(s)
- Masino Tessu Beshir
- Department of Nursing, Wolkite University College of Health Science and Medicine, Wolkite, Ethiopia
| | - Aklil Hailu Beyene
- Department of Nursing, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
| | - Kenean Getaneh Tlaye
- Department of Nursing, Woldia University Faculty of Health Science, Woldia, Ethiopia
| | - Tefera Mulugeta Demelew
- Department of Nursing, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
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Tao NN, Li YF, Liu YX, Liu JY, Song WM, Liu Y, Geng H, Wang SS, Li HC. Epidemiological characteristics of pulmonary tuberculosis among children in Shandong, China, 2005-2017. BMC Infect Dis 2019; 19:408. [PMID: 31077154 PMCID: PMC6511196 DOI: 10.1186/s12879-019-4060-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/01/2019] [Indexed: 01/21/2023] Open
Abstract
Background Diagnosis of tuberculosis (TB) in children is challenging. Epidemiological data of childhood pulmonary tuberculosis (PTB) are urgently needed. Methods We described trends in epidemiology, clinical characteristics, and treatment outcomes in seven cities of Shandong province, China, during 2005–2017. Data were collected from the China Information System for Disease Control and Prevention. Results Among 6283 (2.4% of all PTB) PTB cases aged < 18 years, 56.5% were male patients, 39.3% were smear-positive and 98.6% were new cases. The overall incidence of childhood PTB declined (7.62 to 3.74 per 100,000) during 2005–2017, with a non-significant change of annual percentage after 2010. While the incidence of smear-positive PTB (6.09 to 0.38 per 100,000 population) decreased significantly, but the incidence of smear-negative PTB (1.52 to 3.36 per 100,000 population) increased significantly during 2005–2017. The overall treatment success occurred among 94.2% childhood PTB. Ten children (0.2%) died. Conclusion The overall incidence of childhood PTB declined significantly with the disease burden shifting from smear-positive PTB to smear-negative PTB. The discrepancies between notifications and estimations in both TB morbidity and mortality of children need to be addressed urgently.
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Affiliation(s)
- Ning-Ning Tao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yi-Fan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yun-Xia Liu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Jin-Yue Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Wan-Mei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hong Geng
- Centers for Tuberculosis Control in Shandong province, Jinan, China
| | - Shan-Shan Wang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
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Carvalho ACC, Cardoso CAA, Martire TM, Migliori GB, Sant'Anna CC. Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy. ACTA ACUST UNITED AC 2019; 44:134-144. [PMID: 29791553 PMCID: PMC6044667 DOI: 10.1590/s1806-37562017000000461] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/11/2018] [Indexed: 02/01/2023]
Abstract
Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.
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Affiliation(s)
- Anna Cristina Calçada Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Terezinha Miceli Martire
- Faculdade de Medicina, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Clemax Couto Sant'Anna
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Endalamaw A, Engeda EH, Tezera N. Incidence of tuberculosis in children on antiretroviral therapy: a retrospective cohort study. BMC Res Notes 2018; 11:745. [PMID: 30342550 PMCID: PMC6195951 DOI: 10.1186/s13104-018-3846-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/11/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives Be aware of the burden of tuberculosis among high-risk population is important. Three hundred fifty-two children were participated in this study. Survival analysis was conducted. We assessed the incidence of tuberculosis and its predictors in children on ART. Results Tuberculosis incidence rate in children on ART was 2.63 per 100 person-years. Those children who were on baseline World Health Organization clinical stages 3 and 4 (AHR (adjusted hazard ratio) = 3.0; 95% CI 1.2–7.7), “fair” and “poor” ART adherence (AHR = 4.0; 95% CI 1.5–10.8), late initiation of ART (AHR = 4.0; 95% CI 1.5–10.6), and less than 6 months duration on ART (AHR = 5.5; 95% CI 1.5–20.6) were more likely to develop tuberculosis infection. The incidence rate of TB in children on ART was high. This study suggests a need to give attention to advanced AIDS stages and improve timely initiation of ART and level of adherence to ART.
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Affiliation(s)
- Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia.
| | - Eshetu Hailesilassie Engeda
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
| | - Nega Tezera
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
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Laghari M, Sulaiman SAS, Khan AH, Memon N. Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective study. PeerJ 2018; 6:e5253. [PMID: 30065869 PMCID: PMC6065458 DOI: 10.7717/peerj.5253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/27/2018] [Indexed: 01/26/2023] Open
Abstract
Background Regardless of the advancement in medical technologies, the diagnosis of tuberculosis (TB) in children has remained a challenge. Childhood TB is rampant and an important cause of morbidity and mortality. The objective of this study was to determine the trend of TB and treatment outcomes in children aged ≤14 years registered for TB treatment under DOTS course in three districts of Sindh, Pakistan. Methods For this retrospective study, records of TB children (≤14 years) registered for the treatment of TB from January 2011 to December 2015 in three districts of Pakistan, were collected. Demographic data, baseline weight, clinical manifestations, radiography, histopathology results and treatment outcomes were collected from TB unit registers. Results A total of 2,167 children were treated for TB during the study period. Of these, 1,199 (55.3%) were females and 1,242 (57.3%) were from urban areas. Over three-quarter of patients (76.9%) had pulmonary TB with 13.3% of sputum smear positive cases. The overall treatment success rate was 92.4%. In multivariate analysis, rural residents (OR: 2.146, p < 0.001), sputum smear positive cases (OR: 3.409, p < 0.001) and re-treated patients (OR: 5.919, p < 0.001), were significantly associated with unsuccessful treatment outcomes. However, age group ≤2 years, male and those who were underweight were found to have the highest risk of pulmonary tuberculosis (OR: 1.953, p < 0.001; OR: 1.262, p = 0.028; OR: 1.342, p = 0.008), respectively. Conclusion Patients at risk of treatment failure must be given particular attention. Moreover, strategies are needed to further improve the diagnosis and treatment of TB among children and improve the recording system.
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Affiliation(s)
- Madeeha Laghari
- Department of Clinical Pharmacy, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | | | - Amer Hayat Khan
- Department of Clinical Pharmacy, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Naheed Memon
- College of Pharmacy, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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Abstract
BACKGROUND Point-of-care ultrasound (POCUS) detects extrapulmonary tuberculosis (EPTB) in HIV infected adults but has not been evaluated in children despite their higher risk of EPTB. This study's aims were to investigate feasibility of POCUS for EPTB in children, frequency of POCUS findings suggestive of EPTB and time to sonographic resolution of findings with treatment. METHODS This prospective South African cohort study enrolled children with suspected pulmonary tuberculosis (PTB). POCUS for pleural, pericardial or ascitic effusion, abdominal lymphadenopathy or splenic or hepatic microabscesses was performed and repeated at 1, 3 and 6 months of tuberculosis (TB) treatment. Prevalence of POCUS findings and their association with HIV infection was investigated in children with confirmed PTB (microbiologically proven), unconfirmed PTB (clinically diagnosed) or unlikely TB (respiratory disease that improved during follow-up without TB treatment). RESULTS Of 232 children [median age 37 months (interquartile range, 18-74)], 39 (17%) were HIV infected. Children with confirmed or unconfirmed PTB had a higher prevalence of POCUS findings than children with unlikely TB [18 of 58 (31%) and 36 of 119 (30%) vs. 8 of 55 (15%); P = 0.04 and P = 0.03, respectively]. Pleural effusion [n = 30 (13%)] or abdominal lymphadenopathy [n = 28 (12%)] were the most common findings; splenic microabscesses [n = 12 (5%)] were strongly associated with confirmed PTB. Children coinfected with HIV and TB were more likely than HIV-uninfected children with TB to have abdominal lymphadenopathy (37% vs. 10%; P < 0.001) or splenic microabscesses (23% vs. 3%; P < 0.001]. Most ultrasound findings were resolved by 3 months with appropriate TB treatment. CONCLUSIONS POCUS for EPTB in children with PTB is feasible. The high prevalence of findings suggests that POCUS can contribute to timely diagnosis of childhood TB and to monitoring treatment response.
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Mase A, Ryan S, Mader G, Alvarez A, Armitige L, Chen L, McSherry G, Wilson J, Mase S, Banerjee R. Pediatric tuberculosis consultations across 5 CDC regional tuberculosis training and medical consultation Centers. J Clin Tuberc Other Mycobact Dis 2018; 11:23-27. [PMID: 31720388 PMCID: PMC6830164 DOI: 10.1016/j.jctube.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The U.S. Centers for Disease Control and Prevention (CDC) funds five Regional Tuberculosis Training and Medical Consultation Centers (RTMCCs) that provide training and consultation for tuberculosis (TB) control and management. RTMCC utilization for assistance with diagnosis and management of TB in children has not been described. We analyzed pediatric TB consultations performed across all RTMCCs in terms of question type, provider type, and setting. METHODS The CDC medical consultation database was queried for consultations regarding patients ≤ 18 years provided between 1/1/13-4/22/15 by all RTMCCs (Curry International TB Center, Heartland National TB Center, Mayo Clinic Center for TB, New Jersey Medical School Global TB Institute, Southeastern National TB Center). Each query was categorized into multiple subject areas based on provider type, setting, consultation topic, and patient age. RESULTS The 5 RTMCCs received 1164 pediatric consultation requests, representing approximately 20% of all consultations performed by the centers during the study period. Providers requesting consults were primarily physicians (46.3%) or nurses (45.0%). The majority of pediatric consult requests were from state and local public health departments (679, 58.3%) followed by hospital providers (199, 17.1%); fewer requests came from clinicians in private practice (84, 7.2%) or academic institutions (40, 3.4%). Consults addressed 14 different topics, most commonly management of children with TB disease (19.1%), latent TB infection (LTBI) (18.2%), diagnosis or laboratory testing (18.7%), and pharmacology (9.2%). DISCUSSION Pediatric consultations accounted for approximately 20% of all consultations performed by RTMCCs during the study period. RTMCCs were utilized primarily by public health departments regarding management of TB disease, LTBI, and diagnosis or laboratory testing. The relative underutilization of the RTMCCs by clinicians in non-public health settings, who often manage children with TB exposure or infection, warrants further study. As US TB case rates decline and providers become less experienced with childhood TB, medical consultation support may become increasingly important.
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Affiliation(s)
| | - Stephen Ryan
- Southeastern National Tuberculosis Center, Gainesville, FL, USA
| | | | - Ana Alvarez
- University of Florida, Jacksonville, FL, USA
| | - Lisa Armitige
- University of Texas-Health Northeast, San Antonio, TX, USA
| | - Lisa Chen
- University of California, San Francisco, CA, USA
| | | | | | - Sundari Mase
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Svensson EM, Yngman G, Denti P, McIlleron H, Kjellsson MC, Karlsson MO. Evidence-Based Design of Fixed-Dose Combinations: Principles and Application to Pediatric Anti-Tuberculosis Therapy. Clin Pharmacokinet 2018; 57:591-599. [PMID: 28779464 PMCID: PMC5904239 DOI: 10.1007/s40262-017-0577-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Fixed-dose combination formulations where several drugs are included in one tablet are important for the implementation of many long-term multidrug therapies. The selection of optimal dose ratios and tablet content of a fixed-dose combination and the design of individualized dosing regimens is a complex task, requiring multiple simultaneous considerations. METHODS In this work, a methodology for the rational design of a fixed-dose combination was developed and applied to the case of a three-drug pediatric anti-tuberculosis formulation individualized on body weight. The optimization methodology synthesizes information about the intended use population, the pharmacokinetic properties of the drugs, therapeutic targets, and practical constraints. A utility function is included to penalize deviations from the targets; a sequential estimation procedure was developed for stable estimation of break-points for individualized dosing. The suggested optimized pediatric anti-tuberculosis fixed-dose combination was compared with the recently launched World Health Organization-endorsed formulation. RESULTS The optimized fixed-dose combination included 15, 36, and 16% higher amounts of rifampicin, isoniazid, and pyrazinamide, respectively. The optimized fixed-dose combination is expected to result in overall less deviation from the therapeutic targets based on adult exposure and substantially fewer children with underexposure (below half the target). CONCLUSION The development of this design tool can aid the implementation of evidence-based formulations, integrating available knowledge and practical considerations, to optimize drug exposures and thereby treatment outcomes.
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Affiliation(s)
- Elin M Svensson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Gunnar Yngman
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Maria C Kjellsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Mats O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Tao NN, He XC, Zhang XX, Liu Y, Yu CB, Li HC. Drug-Resistant Tuberculosis among Children, China, 2006-2015. Emerg Infect Dis 2018; 23:1800-1805. [PMID: 29047424 PMCID: PMC5652408 DOI: 10.3201/eid2311.170234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Microbial drug resistance has become a major public health concern worldwide. To acquire epidemiologic data on drug-resistant tuberculosis (DR TB) among children, a major cause of illness and death for this population, we conducted a retrospective study of 2006–2015 data from 36 TB prevention and control institutions in Shandong Province, China. A total of 14,223 new TB cases, among which children (<18 years of age) accounted for only 5.5%, were caused by culture-confirmed Mycobacterium tuberculosis. Among children with TB, 18.9% had DR TB and 6.9% had multidrug-resistant TB. Over the past decade, the percentage of DR TB; multidrug-resistant TB; and overall first-line drug resistance for isoniazid, rifampin, ethambutol, and streptomycin among children increased significantly (at least 12%). Understanding the long-term trends of DR TB among children can shed light on the performance of TB control programs, thereby contributing to global TB control.
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García-Basteiro AL, Schaaf HS, Diel R, Migliori G. Adolescents and young adults: a neglected population group for tuberculosis surveillance. Eur Respir J 2018; 51:51/2/1800176. [DOI: 10.1183/13993003.00176-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
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Lombardi G, Petrucci R, Corsini I, Bacchi Reggiani ML, Visciotti F, Bernardi F, Landini MP, Cazzato S, Dal Monte P. Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis. J Clin Microbiol 2018; 56:e01360-17. [PMID: 29142046 PMCID: PMC5786731 DOI: 10.1128/jcm.01360-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/08/2017] [Indexed: 12/22/2022] Open
Abstract
The use of interferon gamma (IFN-γ) release assays (IGRAs) for the diagnosis of tuberculosis (TB) infection in children is still under debate because of concerns about the immature immune response in children. The aim of this study was to investigate quantitative values of the QuantiFERON-TB Gold In-Tube (QFT-IT) test, a commercially available IGRA, in a large cohort of children screened for TB infection. A retrospective analysis was conducted on samples from 517 children aged 0 to 14 years old at the Pediatric Unit of S. Orsola-Malpighi University Hospital of Bologna (Italy); quantitative responses to QFT-IT stimuli were analyzed according to diagnosis and age. Elevated IFN-γ values in the QFT-IT nil (background) tube were statistically associated with diagnosis of active TB. Quantitative IFN-γ response to Mycobacterium tuberculosis-specific antigens (TB Ag) was not significantly different in children with active TB compared to those with latent TB infection (LTBI), even though the median values were higher in the first group. When children were grouped by age, those less than 5 years old produced significantly higher levels of IFN-γ in response to TB Ag if they had active TB (median 10 IU/ml) than those with LTBI (median 1.96 IU/ml). IFN-γ response to mitogen increased with age. The overall rate of indeterminate results was low (3.9%), and no indeterminate QFT-IT values were observed in active or latent TB patients. In conclusion, quantitative QFT-IT values could provide further information to clinicians to manage TB in children, and these observations could be transferred to the new version of the test, QuantiFERON-TB Gold Plus, which to date lacks data from the pediatric population.
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Affiliation(s)
- Giulia Lombardi
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Roberta Petrucci
- Paediatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ilaria Corsini
- Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Filippo Bernardi
- Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maria Paola Landini
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Cazzato
- Paediatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Dal Monte
- Department of Experimental, Diagnostic and Specialty Medicine-Microbiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Volkmann T, Nguyen B, Anyalechi EG, Chapman Hedges KN, Van Anh H, Tue PQ, Nhung NV, Click ES. Comparison of HIV Testing among Children and Adults with Tuberculosis, Vietnam. ACTA ACUST UNITED AC 2017; 5:292-297. [PMID: 29349098 PMCID: PMC5769957 DOI: 10.4236/jtr.2017.54030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
HIV testing among persons with tuberculosis (TB) results in high-yield identification of persons infected with HIV. To evaluate differences in HIV testing among children versus adults with TB in Vietnam, we collected and analyzed age-disaggregated facility and aggregated provincial data from the National Tuberculosis Program. HIV testing was incompletely documented for >70% of children, whereas adult testing data were >90% complete. Standardized training of personnel for universal HIV testing and documentation for children with TB could improve HIV case-detection and permit linking of children with HIV to antiretroviral treatment to prevent morbidity and mortality.
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Affiliation(s)
- Tyson Volkmann
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | - Binh Nguyen
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Ho Van Anh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Eleanor S Click
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
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Abstract
Ultrasound reports of 102 children with microbiologically confirmed or clinically diagnosed pulmonary tuberculosis (TB) showed that 23 of 37 (64%) and 23 of 65 (36%) had TB suggestive abdominal lymphadenopathy, and 16 of 37 (44%) and 8 of 65 (13%) had splenic microabscesses, respectively. Splenic microabscesses were associated with HIV infection (P = 0.041). These data suggest that pulmonary TB is often complicated by abdominal TB in children.
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Duke T, Kasa Tom S, Poka H, Welch H. Holistic care of complicated tuberculosis in healthcare settings with limited resources. Arch Dis Child 2017; 102:1161-1168. [PMID: 28912165 PMCID: PMC5754861 DOI: 10.1136/archdischild-2017-313095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/03/2022]
Abstract
In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries. The care of these children requires a holistic clinical and continuous quality improvement approach. This includes timely decisions on the commencement of treatment often when diagnoses are not certain, identification and management of acute respiratory, neurological and nutritional complications, identification and treatment of comorbidities, supportive care, systematic monitoring of treatment and progress, rehabilitation, psychological support, ensuring adherence, and safe transition to community care. New diagnostics and imaging can assist this, but meticulous attention to clinical detail at the bedside and having a clear plan for all aspects of care that is communicated well to staff and families are essential for good outcomes. The care is multidimensional: biomedical, rehabilitative, social and economic, and multidisciplinary: medical, nursing and allied health. In the era of the Sustainable Development Goals, approaches to these dimensions of healthcare are needed within the reach of the poorest people who access district hospitals in low-income countries.
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia,Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia,Discipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Moresby, Papua New Guinea
| | - Sharon Kasa Tom
- Department of Paediatrics, Wabag General Hospital, Wabag, Papua New Guinea
| | - Harry Poka
- Department of Paediatrics, Sir Joseph Nombri Memorial Kundiawa General Hospital, Kundiawa, Simbu, Papua New Guinea
| | - Henry Welch
- Discipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Moresby, Papua New Guinea,Department of Pediatrics, Baylor College of Medicine, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
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45
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Kitai I, Morris SK, Kordy F, Lam R. Diagnosis and management of pediatric tuberculosis in Canada. CMAJ 2017; 189:E11-E16. [PMID: 28246254 DOI: 10.1503/cmaj.151212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ian Kitai
- Division of Infectious Diseases (Kitai, Morris, Kordy, Lam); Centre for Global Child Health (Morris), Hospital for Sick Children; Department of Pediatrics (Kitai, Morris); Faculty of Nursing (Lam), University of Toronto, Toronto, Ont.
| | - Shaun K Morris
- Division of Infectious Diseases (Kitai, Morris, Kordy, Lam); Centre for Global Child Health (Morris), Hospital for Sick Children; Department of Pediatrics (Kitai, Morris); Faculty of Nursing (Lam), University of Toronto, Toronto, Ont
| | - Faisal Kordy
- Division of Infectious Diseases (Kitai, Morris, Kordy, Lam); Centre for Global Child Health (Morris), Hospital for Sick Children; Department of Pediatrics (Kitai, Morris); Faculty of Nursing (Lam), University of Toronto, Toronto, Ont
| | - Ray Lam
- Division of Infectious Diseases (Kitai, Morris, Kordy, Lam); Centre for Global Child Health (Morris), Hospital for Sick Children; Department of Pediatrics (Kitai, Morris); Faculty of Nursing (Lam), University of Toronto, Toronto, Ont
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46
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Adamu AL, Aliyu MH, Galadanci NA, Musa BM, Gadanya MA, Gajida AU, Amole TG, Bello IW, Gambo S, Abubakar I. Deaths during tuberculosis treatment among paediatric patients in a large tertiary hospital in Nigeria. PLoS One 2017; 12:e0183270. [PMID: 28817675 PMCID: PMC5560640 DOI: 10.1371/journal.pone.0183270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite availability of effective cure, tuberculosis (TB) remains a leading cause of death in children. In many high-burden countries, childhood TB is underdiagnosed and underreported, and care is often accessed too late, resulting in adverse treatment outcomes. In this study, we examined the time to death and its associated factors among a cohort of children that commenced TB treatment in a large treatment centre in northern Nigeria. Methods This is a retrospective cohort study of children that started TB treatment between 2010 and 2014. We determined mortality rates per 100 person-months of treatment, as well as across treatment and calendar periods. We used Cox proportional hazards regression to determine adjusted hazard ratios (aHR) for factors associated with mortality. Results Among 299 children with a median age 4 years and HIV prevalence of 33.4%; 85 (28.4%) died after 1,383 months of follow-up. Overall mortality rate was 6.1 per 100 person-months. Deaths occurred early during treatment and declined from 42.4 per 100 person-months in the 1st week of treatment to 2.2 per 100 person-months after at the 3rd month of treatment. Mortality was highest between October to December period (9.1 per 100 pm) and lowest between July and September (2.8 per 100 pm). Risk factors for mortality included previous TB treatment (aHR 2.04:95%CI;1.09–3.84); HIV infection (aHR 1.66:95%CI;1.02–2.71), having either extra-pulmonary disease (aHR 2.21:95%CI;1.26–3.89) or both pulmonary and extrapulmonary disease (aHR 3.03:95%CI;1.70–5.40). Conclusions Mortality was high and occurred early during treatment in this cohort, likely indicative of poor access to prompt TB diagnosis and treatment. A redoubling of efforts at improving universal health coverage are required to achieve the End TB Strategy target of zero deaths from TB.
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Affiliation(s)
- Aishatu L. Adamu
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
- * E-mail:
| | - Muktar H. Aliyu
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Vanderbilt Institute of Global Health, Nashville, TN, United States of America
| | | | - Baba Maiyaki Musa
- Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Muktar A. Gadanya
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Auwalu U. Gajida
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Taiwo G. Amole
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Imam W. Bello
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
- Department of Public Health and Disease Control, Kano State Ministry of Health, Nigeria
| | - Safiya Gambo
- Department of Paediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
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Singh AR, Kharate A, Bhat P, Kokane AM, Bali S, Sahu S, Verma M, Nagar M, Kumar AMV. Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study from Bhopal, India. J Trop Pediatr 2017; 63:274-285. [PMID: 28082666 PMCID: PMC5914486 DOI: 10.1093/tropej/fmw086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers' and parents' perspectives in Bhopal, India. METHODS A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents). RESULTS Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation. CONCLUSION National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.
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Affiliation(s)
- Akash Ranjan Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India,Correspondence: Akash Ranjan Singh, Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh 462020, India. Tel: +917898594977. E-mail: <>
| | | | - Prashant Bhat
- Department of Health and Family Welfare, Government of Karnataka, Udupi, India
| | - Arun M Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Swaroop Sahu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Mukesh Nagar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Ajay MV Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India,International Union Against Tuberculosis and Lung Disease, Paris, France
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Abstract
One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.
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49
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Lalor MK, Anderson LF, Hamblion EL, Burkitt A, Davidson JA, Maguire H, Abubakar I, Thomas HL. Recent household transmission of tuberculosis in England, 2010-2012: retrospective national cohort study combining epidemiological and molecular strain typing data. BMC Med 2017; 15:105. [PMID: 28606177 PMCID: PMC5469076 DOI: 10.1186/s12916-017-0864-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/27/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We estimate the proportion of tuberculosis (TB) in England due to recent household transmission, identify factors associated with being a household transmitter, and investigate the impact that identification of a case has on time to treatment of subsequent cases. METHODS TB cases notified between 2010 and 2012 in England in the same household as another case were identified; 24 locus MIRU-VNTR strain typing (ST) was used to identify household cases with likely recent transmission. Treatment delay in index and subsequent cases was compared. Risk factors for being a household transmitter were identified in univariable and multivariable analyses. RESULTS Overall, 7.7% (1849/24,060) of TB cases lived in a household with another case. We estimate that 3.9% were due to recent household transmission. ST data was unavailable for 67% (1242) of household pairs. For those with ST data, 64% (386) had confirmed, 11% probable (66) and 25% (155) refuted household transmission. The median treatment delay was 65 days for index cases and 37 days for subsequent asymptomatic cases. Risk factors for being a household transmitter included being under 25 years old, UK-born with Black African, Indian or Pakistani ethnicity, or born in Somalia or Romania. CONCLUSIONS This study has a number of implications for household TB contact tracing in low incidence countries, including the potential to reduce the diagnostic delay for subsequent household cases and the benefit of using ST to identify when to conduct source contact tracing outside the household. As 25% of TB cases in households had discordant strains, households with multiple TB cases do not necessarily represent household transmission. The additional fact that 25% of index cases within households only had extra-pulmonary TB demonstrates that, if household contact tracing is limited to pulmonary TB cases (as recently recommended in UK guidelines), additional cases of active TB in households will be missed. Our finding that no lineage of TB was associated with recent household transmission and with no increased transmissibility in the Beijing lineage compared to others, suggests that the lineage need not impact contact tracing efforts. Improvements in contact tracing have the potential to reduce transmission of TB in low incidence countries.
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Affiliation(s)
- Maeve K Lalor
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK. .,Institute for Global Health, University College London, London, UK.
| | - Laura F Anderson
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
| | - Esther L Hamblion
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - Andy Burkitt
- Field Epidemiology Services, National Infection Service, Public Health England, London, UK.,Field Epidemiology Services, National Infection Service, Public Health England, Newcastle upon Tyne, UK
| | - Jennifer A Davidson
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
| | - Helen Maguire
- Institute for Global Health, University College London, London, UK.,Field Epidemiology Services, National Infection Service, Public Health England, London, UK
| | - Ibrahim Abubakar
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
| | - H Lucy Thomas
- TB Section, Centre for Infectious Disease Surveillance, National Infection Service, Public Health England, London, UK
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50
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Graustein AD, Horne DJ, Fong JJ, Schwarz F, Mefford HC, Peterson GJ, Wells RD, Musvosvi M, Shey M, Hanekom WA, Hatherill M, Scriba TJ, Thuong NTT, Mai NTH, Caws M, Bang ND, Dunstan SJ, Thwaites GE, Varki A, Angata T, Hawn TR. The SIGLEC14 null allele is associated with Mycobacterium tuberculosis- and BCG-induced clinical and immunologic outcomes. Tuberculosis (Edinb) 2017; 104:38-45. [PMID: 28454648 PMCID: PMC7289319 DOI: 10.1016/j.tube.2017.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 10/20/2022]
Abstract
Humans exposed to Mycobacterium tuberculosis (Mtb) have variable susceptibility to tuberculosis (TB) and its outcomes. Siglec-5 and Siglec-14 are members of the sialic-acid binding lectin family that regulate immune responses to pathogens through inhibitory (Siglec-5) and activating (Siglec-14) domains. The SIGLEC14 coding sequence is deleted in a high proportion of individuals, placing a SIGLEC5-like gene under the expression of the SIGLEC14 promoter (the SIGLEC14 null allele) and causing expression of a Siglec-5 like protein in monocytes and macrophages. We hypothesized that the SIGLEC14 null allele was associated with Mtb replication in monocytes, T-cell responses to the BCG vaccine, and clinical susceptibility to TB. The SIGLEC14 null allele was associated with protection from TB meningitis in Vietnamese adults but not with pediatric TB in South Africa. The null allele was associated with increased IL-2 and IL-17 production following ex-vivo BCG stimulation of blood from 10 week-old South African infants vaccinated with BCG at birth. Mtb replication was increased in THP-1 cells overexpressing either Siglec-5 or Siglec-14 relative to controls. To our knowledge, this is the first study to demonstrate an association between SIGLEC expression and clinical TB, Mtb replication, or BCG-specific T-cell cytokines.
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MESH Headings
- Adaptive Immunity
- Adolescent
- Adult
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/genetics
- Antigens, Differentiation, Myelomonocytic/immunology
- BCG Vaccine/administration & dosage
- BCG Vaccine/immunology
- Case-Control Studies
- Child, Preschool
- Cytokines/immunology
- Female
- Gene Frequency
- Genetic Predisposition to Disease
- Host-Pathogen Interactions
- Humans
- Infant
- Infant, Newborn
- Lectins/genetics
- Lectins/immunology
- Male
- Monocytes/immunology
- Monocytes/microbiology
- Mycobacterium tuberculosis/growth & development
- Mycobacterium tuberculosis/immunology
- Phenotype
- Prospective Studies
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/immunology
- South Africa
- T-Lymphocytes/immunology
- T-Lymphocytes/microbiology
- THP-1 Cells
- Time Factors
- Treatment Outcome
- Tuberculosis, Meningeal/genetics
- Tuberculosis, Meningeal/immunology
- Tuberculosis, Meningeal/microbiology
- Tuberculosis, Meningeal/prevention & control
- Tuberculosis, Pulmonary/genetics
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/prevention & control
- Vaccination
- Vietnam
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Affiliation(s)
| | | | - Jerry J Fong
- Univ. of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - Munyaradzi Musvosvi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, Univ. of Cape Town, Cape Town, South Africa
| | - Muki Shey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, Univ. of Cape Town, Cape Town, South Africa
| | - Willem A Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, Univ. of Cape Town, Cape Town, South Africa
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, Univ. of Cape Town, Cape Town, South Africa
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, Univ. of Cape Town, Cape Town, South Africa
| | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Nguyen Thi Hoang Mai
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Maxine Caws
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Nguyen Duc Bang
- Pham Ngoc Thac Hospital for Tuberculosis and Lung Disease, Ho Chi Minh City, Viet Nam
| | - Sarah J Dunstan
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Australia
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, University of Oxford, UK
| | - Ajit Varki
- Univ. of California San Diego, La Jolla, CA, USA
| | - Takashi Angata
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan
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