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Xu CJ, Lu PX, Li CH, He YL, Fang WJ, Xie RM, Jin GQ, Lu YB, Zheng QT, Zheng GP, Lv SX, Huang H, Li L, Ren M, Shi YX, Wen XN, Li L, Wei FJ, Hou DL, Lv Y, Shan F, Wu ZC, Hu ZL, Zhang XR, Liu DX, Shi WY, Li HR, Zhang N, Song M, Zhang X, Deng YY, Li J, Liu Q, Li D, Zhao L, Chen BD, Shi YB, Jiang FL, Tang X, Wu LJ, Ma W, Xu XY, Li HJ. Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis. Quant Imaging Med Surg 2024; 14:1039-1060. [PMID: 38223121 PMCID: PMC10784038 DOI: 10.21037/qims-23-1223] [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: 08/27/2023] [Accepted: 09/23/2023] [Indexed: 01/16/2024]
Abstract
Tuberculosis (TB) remains one of the major infectious diseases in the world with a high incidence rate. Drug-resistant tuberculosis (DR-TB) is a key and difficult challenge in the prevention and treatment of TB. Early, rapid, and accurate diagnosis of DR-TB is essential for selecting appropriate and personalized treatment and is an important means of reducing disease transmission and mortality. In recent years, imaging diagnosis of DR-TB has developed rapidly, but there is a lack of consistent understanding. To this end, the Infectious Disease Imaging Group, Infectious Disease Branch, Chinese Research Hospital Association; Infectious Diseases Group of Chinese Medical Association of Radiology; Digital Health Committee of China Association for the Promotion of Science and Technology Industrialization, and other organizations, formed a group of TB experts across China. The conglomerate then considered the Chinese and international diagnosis and treatment status of DR-TB, China's clinical practice, and evidence-based medicine on the methodological requirements of guidelines and standards. After repeated discussion, the expert consensus of imaging diagnosis of DR-PB was proposed. This consensus includes clinical diagnosis and classification of DR-TB, selection of etiology and imaging examination [mainly X-ray and computed tomography (CT)], imaging manifestations, diagnosis, and differential diagnosis. This expert consensus is expected to improve the understanding of the imaging changes of DR-TB, as a starting point for timely detection of suspected DR-TB patients, and can effectively improve the efficiency of clinical diagnosis and achieve the purpose of early diagnosis and treatment of DR-TB.
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Affiliation(s)
- Chuan-Jun Xu
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Pu-Xuan Lu
- Department of Medical Imaging, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Chun-Hua Li
- Department of Radiology, Chongqing Public Health Medical Center, Chongqing, China
| | - Yu-Lin He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Jun Fang
- Department of Radiology, Guangzhou Chest Hospital, Guangzhou, China
| | - Ru-Ming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Guan-Qiao Jin
- Department of Radiology, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Bo Lu
- Department of Radiology, The Fourth People’s Hospital of Nanning, Nanning, China
| | - Qiu-Ting Zheng
- Department of Medical Imaging, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Guang-Ping Zheng
- Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Sheng-Xiu Lv
- Department of Radiology, Chongqing Public Health Medical Center, Chongqing, China
| | - Hua Huang
- Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Li Li
- Department of Radiology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Meiji Ren
- Department of Radiology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yu-Xin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xin-Nian Wen
- Department of Medical Imaging, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Lin Li
- Department of Radiology, Linyi People’s Hospital, Linyi, China
| | - Fang-Jun Wei
- Department of Radiology, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Dai-Lun Hou
- Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yan Lv
- Department of Medical Imaging, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Zheng-Can Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhi-Liang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiang-Rong Zhang
- Department of Pulmonary Tuberculosis, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Du-Xian Liu
- Department of Pathology, The Second Hospital of Nanjing, Nanjing, China
| | - Wei-Ya Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Hui-Ru Li
- Department of Radiology, Guangzhou Chest Hospital, Guangzhou, China
| | - Na Zhang
- Department of Radiology, Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Min Song
- Department of Radiology, Guangzhou Chest Hospital, Guangzhou, China
| | - Xin Zhang
- Department of Medical Imaging, The Fourth People’s Hospital of Huai’an, Huai’an, China
| | - Ying-Ying Deng
- Department of Radiology, Shenzhen Yantian District People’s Hospital, Shenzhen, China
| | - Jinlong Li
- Department of Laboratory Medicine, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiang Liu
- Department of Radiology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Dechun Li
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Lingling Zhao
- Department of Radiology, The Sixth Peoples Hospital of Zhengzhou, Zhengzhou, China
| | - Bu-Dong Chen
- Medical Imaging Quality Research Committee, China Quality Association for Pharmaceuticals, Beijing, China
| | - Yan-Bin Shi
- Department of Radiology, The Sixth Peoples Hospital of Zhengzhou, Zhengzhou, China
| | - Feng-Li Jiang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xin Tang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Ji Wu
- Department of Imaging, Fourth Hospital of Inner Mongolia Autonomous, Hohhot, China
| | - Wei Ma
- Department of Radiology, The Third People’s Hospital of Longgang, Shenzhen, China
| | - Xin-Yue Xu
- The School of Radiation Medicine and Protection (SRMP) of Soochow University, Suzhou, China
| | - Hong-Jun Li
- Department of Radiology, Beijing You’an Hospital, Capital Medical University, Beijing, China
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Foster J, Marais BJ, Mendez D, McBryde ES. Critical Review of Tuberculosis Diagnosis in Children from Papua New Guinea Presenting to Health Facilities in the Torres Strait Islands, Australia. Microorganisms 2023; 11:2947. [PMID: 38138091 PMCID: PMC10745913 DOI: 10.3390/microorganisms11122947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Paediatric tuberculosis can be challenging to diagnose, and various approaches are used in different settings. A retrospective review was conducted on Papua New Guinea (PNG) children with presumptive TB who presented for health care in the Torres Strait Islands, Australia, between 2016 and 2019. We compared diagnostic algorithms including the modified Keith Edwards TB Score, The Union Desk Guide, and the new World Health Organization (WHO) algorithm, with diagnostic practices used in the remote Torres Strait Islands. Of the 66 children with presumptive TB, 7 had bacteriologically confirmed TB. The majority (52%) were under 5 years (median age 61 months), and 45% were malnourished. There was moderate agreement across the diagnostic methods (K = 0.34; 95% CI 0.23-0.46), with the highest concordance observed between The Union Desk Guide and the WHO's algorithm (K = 0.61). Local TB physicians might have over-diagnosed presumed lymph node TB while under-diagnosing TB overall. Enhancing the precision and promptness of paediatric TB diagnosis using practical tools is pivotal to decrease TB-related child mortality, notably in isolated regions like the Torres Strait and the Western Province of PNG.
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Affiliation(s)
- J’Belle Foster
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
- Torres and Cape Tuberculosis Control Unit, Thursday Island, QLD 4875, Australia
| | - Ben J. Marais
- WHO Collaborating Centre in Tuberculosis, Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Westmead, NSW 2145, Australia;
| | - Diana Mendez
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Emma S. McBryde
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
- Torres and Cape Tuberculosis Control Unit, Thursday Island, QLD 4875, Australia
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Linn AR, Dubois MM, Steenhoff AP. Under-Reporting of Tuberculosis Disease among Children and Adolescents in Low and Middle-Income Countries: A Systematic Review. Trop Med Infect Dis 2023; 8:300. [PMID: 37368718 DOI: 10.3390/tropicalmed8060300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Under-reporting of tuberculosis (TB) disease in children and adolescents is a significant global concern, as many children are missing from TB notification data. A systematic literature review was conducted to understand the global reporting gap of child and adolescent TB as well as current interventions to close this gap in Low- and Middle- Income Countries (LMIC). Our study found large and variable gaps in child and adolescent TB reporting, due to various factors. Interventions to close this gap exist but are limited. Future studies are necessary to improve global surveillance systems to improve TB care delivery for children and adolescents.
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Affiliation(s)
- Alexandra R Linn
- Global Health Center, Children's Hospital of Philadelphia & Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Melanie M Dubois
- Division of Pediatric Infectious Diseases, Weill Cornell Medicine, New York, NY 10065, USA
| | - Andrew P Steenhoff
- Global Health Center, Children's Hospital of Philadelphia & Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Rampedi PN, Ogunrombi MO, Wesley-Smith J, Adeleke OA. A Micro-Configured Multiparticulate Reconstitutable Suspension Powder of Fixed Dose Rifampicin and Pyrazinamide: Optimal Fabrication and In Vitro Quality Evaluation. Pharmaceutics 2022; 15:pharmaceutics15010064. [PMID: 36678693 PMCID: PMC9861895 DOI: 10.3390/pharmaceutics15010064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The scarcity of age-appropriate pharmaceutical formulations is one of the major challenges impeding successful management of tuberculosis (TB) prevalence in minors. To this end, we designed and assessed the quality of a multiparticulate reconstitutable suspension powder containing fixed dose rifampicin and pyrazinamide (150 mg/300 mg per 5 mL) which was prepared employing solid−liquid direct dispersion coupled with timed dehydration, and mechanical pulverization. The optimized formulation had a high production yield (96.000 ± 3.270%), displayed noteworthy powder flow quality (9.670 ± 1.150°), upon reconstitution the suspension flow property was non-Newtonian and was easily redispersible with gentle manual agitation (1.720 ± 0.011 strokes/second). Effective drug loading was attained for both pyrazinamide (97.230 ± 2.570%w/w) and rifampicin (97.610 ± 0.020%w/w) and drug release followed a zero-order kinetic model (R2 = 0.990) for both drugs. Microscopic examinations confirmed drug encapsulation efficiency and showed that the particulates were micro-dimensional in nature (n < 700.000 µm). The formulation was physicochemically stable with no chemically irreversible drug-excipient interactions based on the results of characterization experiments performed. Findings from organoleptic evaluations generated an overall rating of 4.000 ± 0.000 for its attractive appearance and colour 5.000 ± 0.000 confirming its excellent taste and extremely pleasant smell. Preliminary cytotoxicity studies showed a cell viability above 70.000% which indicates that the FDC formulation was biocompatible. The optimized formulation was environmentally stable either as a dry powder or reconstituted suspension. Accordingly, a stable and palatable FDC antimycobacterial reconstitutable oral suspension powder, intended for flexible dosing in children and adolescents, was optimally fabricated.
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Affiliation(s)
- Penelope N. Rampedi
- Division of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Modupe O. Ogunrombi
- Department of Clinical Pharmacology and Therapeutics, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - James Wesley-Smith
- Electron Microscope Unit, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Oluwatoyin A. Adeleke
- Division of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Faculty of Health, College of Pharmacy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Correspondence: or
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