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Miranda-Schaeubinger M, Derbew HM, Ramirez A, Smith M, Jalloul M, Andronikou S, Otero HJ. Frequency of abnormal findings on chest radiograph after positive PPD in children and adolescents in an urban setting in the United States. Clin Imaging 2024; 105:110024. [PMID: 37989019 DOI: 10.1016/j.clinimag.2023.110024] [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: 08/09/2023] [Revised: 10/17/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Chest radiographs (CXR) for tuberculosis (TB) screening in children are valuable in high-burden settings. However, less certain in low prevalence contexts. In the United States, positive PPD is sufficient to treat for "latent" TB, or TB infection in asymptomatic patients. OBJECTIVE We sought to determine frequency of abnormal CXR findings after a positive purified protein derivative (PPD) test at a tertiary pediatric center in the United States. METHOD A retrospective evaluation was conducted of patients (0-18 years) with a CXR after a positive PPD (e.g., known exposure, employment, migratory requirements or before immunosuppression) between 2011 and 2021. Clinical information, demographics, and reason for PPD were recorded from health record. CXRs were evaluated using initial report and by a pediatric radiologist with special interest in TB and 8 years of experience. RESULT Of 485 patients, median [interquartile range (IQR)] age 8.5[3.3-14.4], abnormal CXRs were described in 5 (1%). Most common reasons for PPD included: close contact with someone with TB or with high risk for TB. Most patients 373 (76.9%) received treatment for latent TB, and 111 (22.9%) no treatment. One patient (0.2%) received treatment for active disease. Radiographic findings included isolated lymphadenopathy (n = 2), consolidation (n = 1), pleural fluid/thickening (n = 1) and a patient with lymphadenopathy and a calcified nodule (n = 1). CONCLUSION In our experience, prevalence of chest radiographs findings for patients with positive PPD was very low. Moreover, no cases of severe disease were seen and those with abnormal findings would not merit treatment change under current WHO guidelines.
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Affiliation(s)
- Monica Miranda-Schaeubinger
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Hermon Miliard Derbew
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alexandra Ramirez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Maretta Smith
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Mohammad Jalloul
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Price A, Graham DY, Tan MC. Controversies regarding management of Helicobacter pylori infections. Curr Opin Gastroenterol 2023; 39:482-489. [PMID: 37678189 PMCID: PMC10592071 DOI: 10.1097/mog.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies. RECENT FINDINGS We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy. SUMMARY Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.
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Affiliation(s)
- Alyssa Price
- Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - David Y. Graham
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Mimi C. Tan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Rangchaikul P, Ahn P, Nguyen M, Zhong V, Venketaraman V. Review of Pediatric Tuberculosis in the Aftermath of COVID-19. Clin Pract 2022; 12:738-754. [PMID: 36136871 PMCID: PMC9498527 DOI: 10.3390/clinpract12050077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
In 2014, the World Health Organization developed the End Tuberculosis Strategy with the goal of a 95% reduction in deaths from tuberculosis (TB) by 2035. The start of the COVID-19 pandemic and global lockdown has had a major impact on TB awareness, screening, diagnosis, and prompt initiation of treatment, inevitably leading to a significant setback. We explore pediatric tuberculosis through the lens of the COVID-19 era, investigating how COVID-19 has impacted pediatric TB cases in different regions of the world and what the implications are for management moving forward to mitigate these effects. Furthermore, in light of recent findings showing how exposed infants and children are at higher risk than we thought of contracting the disease, greater attention and resources are needed to prevent further downward trends.
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Lai CC, Hsu CY, Hsieh YC, Yeh YP, Chen HH. The effect of combining QuantiFERON-TB Gold In-Tube test with tuberculin skin test on the detection of active tuberculosis. Trans R Soc Trop Med Hyg 2019; 112:245-251. [PMID: 29860478 DOI: 10.1093/trstmh/try043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background Interferon-γ release assays (IGRAs) and tuberculin skin tests (TSTs) play an important role in the detection of tuberculosis (TB) infection. However, the interaction between these tests in detecting active pulmonary TB in adults has never been researched. Methods A matched case-control study was conducted in Taiwan from 1 March 2012 to 31 December 2013 by enrolling 150 confirmed TB cases and 852 matched controls dwelling at the same area (stratified by low, medium and high incidence). Results Compared with a negative QuantiFERON-TB Gold In-Tube (QFT-GIT) test and a negative tuberculin skin test (TST), the effect size for detecting active pulmonary TB was highest for both a positive QFT-GIT and positive TST (adjusted odds ratio [aOR] 8.77 [95% confidence interval {CI} 4.51 to 17.05]), but the detectability was substantially attenuated in the absence of either a positive TST (aOR 1.59 [95% CI 0.70 to 3.63]) or positive QFT-GIT (aOR 1.15 [95% CI 0.48 to 2.71]) after controlling for age and gender. The joint effect of detecting active TB was positively synergistic according to a large positive value of relative excess risk due to interaction (7.05 [95% CI 2.48 to 11.61]). Conclusions The administration of both the IGRA and TST for enhancing the detectability of active pulmonary TB in an area with a moderate prevalence of TB such as Taiwan is strongly suggested.
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Affiliation(s)
- Chao-Chih Lai
- Emergency Department of Taipei City Hospital, Ren-Ai Branch, Taiwan. No.10, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. 5 Fl. No. 17, Hsu Chow Road, Taipei, Taiwan
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. 5 Fl. No. 17, Hsu Chow Road, Taipei, Taiwan
| | - Yu-Chu Hsieh
- Changhua Health Bureau, No. 162, Sec. 2, Jhongshan Road, Changhua City, Changhua County, Taiwan
| | - Yen-Po Yeh
- Changhua Health Bureau, No. 162, Sec. 2, Jhongshan Road, Changhua City, Changhua County, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. 5 Fl. No. 17, Hsu Chow Road, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan. No. 17, Hsu Chow Road, Taipei, Taiwan
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Pediatric Latent Tuberculosis: Should Travel and Foreign Birth Testing Criteria Be Reassessed? Pediatr Infect Dis J 2016; 35:977-8. [PMID: 27182897 DOI: 10.1097/inf.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep 2010; 125 Suppl 4:34-42. [PMID: 20626191 DOI: 10.1177/00333549101250s407] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The institutional and community norms that lead to the stigmatization of tuberculosis (TB) are thought to hinder TB control. We performed a systematic review of the literature on TB stigma to identify the causes and evaluate the impact of stigma on TB diagnosis and treatment. Several themes emerged: fear of infection is the most common cause of TB stigma; TB stigma has serious socioeconomic consequences, particularly for women; qualitative approaches to measuring TB stigma are more commonly utilized than quantitative surveys; TB stigma is perceived to increase TB diagnostic delay and treatment noncompliance, although attempts to quantify its impact have produced mixed results; and interventions exist that may reduce TB stigma. Future research should continue to characterize TB stigma in different populations; use validated survey instruments to quantify the impact of TB stigma on TB diagnostic delay, treatment compliance, and morbidity and mortality; and develop additional TB stigma-reduction strategies.
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Affiliation(s)
- Andrew Courtwright
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Yawkey 4B, Ste. 4700, Boston, MA 02114, USA.
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Minodier P, Lamarre V, Carle ME, Blais D, Ovetchkine P, Tapiero B. Evaluation of a school-based program for diagnosis and treatment of latent tuberculosis infection in immigrant children. J Infect Public Health 2010; 3:67-75. [PMID: 20701894 DOI: 10.1016/j.jiph.2010.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/05/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate a 10-year school-based latent tuberculosis infection (LTBI) screening program, targeting immigrant children in Montreal, Canada, and to identify predictive factors for refusal and, poor adherence to treatment. METHODS Immigrant children were screened for LTBI with Tuberculin Skin Test (TST). Isoniazid was, given when LTBI was diagnosed. Predictors of LTBI, of refusal of follow-up and treatment and of poor, adherence to isoniazid were analyzed. RESULTS Four thousand three hundred and seventy-five children were offered screening, 82.3% consented to TST and 22.8% were positive. An, older age at migration (odds ratio (OR)=1 [95% CI: 1.0-1.01]), as well as migration from a none, established market economy country (OR varying from 2.41 to 4.23) were significantly associated with, positive TST. Among positive children, further evaluation was refused in 5.7%, mainly in migrants from, Eastern Europe (OR=4.05 [95% CI: 2.14-7.69]). Refusal of treatment (11.2%) was more frequent in, Eastern European when compared to South-eastern Asian (OR=6.91 [95% CI: 1.56-30.75]), in, blended families (OR=3.25 [95% CI: 1.25-8.46]) and when the first visit to hospital was delayed (OR=1.01 [95% CI: 1.0-1.02]). Adequate completion of treatment was noted in 61.3%. Age>16 years (OR=1.82 [95% CI: 1.82-2.99]), a delay between TST and first visit>15 days (OR=1.6 [95% CI: 1.12-2.28]), as well as the presence of relative>18 years in the household (OR=1.56 [95% CI: 1.0-2.43]), were associated with poor adherence to treatment. CONCLUSION Sociocultural and behavioural factors are involved in acceptance of LTBI treatment in, immigrant children. Adherence to treatment is challenging and requires comperhension of sociocultural beliefs and accessibility to TB clinic.
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Affiliation(s)
- Philippe Minodier
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte Justine - Université de Montréal, 3175 Côte Sainte Catherine, Montréal, QC, Canada H3T 1C5
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Dandoulakis M, Roussos N, Karageorgopoulos DE, Yatromanolakis N, Falagas ME. Trends of tuberculin skin test positivity rate among schoolchildren in Attica, Greece. ACTA ACUST UNITED AC 2009; 41:195-200. [DOI: 10.1080/00365540902721392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kahn P. Evaluation of a Tuberculosis Skin Testing Program. J Sch Nurs 2009; 25:48-54. [DOI: 10.1177/1059840508328589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There has been a recent slowdown in the decline of rates of tuberculosis (TB) in the United States. However, there are disparities in TB diagnosis between U.S.-born and foreign-born persons and between Whites and minorities. Measures for achieving TB elimination include identification of high-risk persons, including children and adolescents, at increased risk of progression to TB disease. A public school district TB skin-testing program was evaluated to determine the program’s efficacy in diagnosing infectious TB and the financial effect of the program on the district. Analysis of the correlation between ethnicity and a positive skin test was also performed. Results showed the TB screening program did not identify any cases of infectious TB and found no statistically significant relationship between positive test results and student ethnicity. It was also demonstrated that the school district lost state funds due to days of school missed in relation to the screening process.
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Affiliation(s)
- Pamela Kahn
- Pamela Kahn, MPH, RN, is Coordinator, Health and Wellness, Orange County Department of Education, Costa Mesa, CA
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Lobato MN, Jereb JA, Starke JR. Unintended consequences: mandatory tuberculin skin testing and severe isoniazid hepatotoxicity. Pediatrics 2008; 121:e1732-3. [PMID: 18474531 DOI: 10.1542/peds.2007-2773] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
After mandatory school-enrollment tuberculin skin testing, a 4-year-old girl who was at low risk for Mycobacterium tuberculosis infection had severe isoniazid hepatotoxicity that was managed with a liver transplant. Although severe isoniazid hepatotoxicity is very uncommon in children, this case emphasizes the need to limit skin testing to persons who have a risk factor for infection and to educate parents on how to monitor for adverse effects during treatment.
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Affiliation(s)
- Mark N Lobato
- Connecticut Department of Public Health, 410 Capitol Ave, MS 11-TUB, PO Box 340308, Hartford, CT 06134, USA.
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Potter P. On the Threshold of Illness and Emotional Isolation. Emerg Infect Dis 2006. [PMCID: PMC3374451 DOI: 10.3201/eid1205.ac1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Polyxeni Potter
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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