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Rodrigues C, Singhal T. What is New in the Diagnosis of Childhood Tuberculosis? Indian J Pediatr 2024; 91:717-723. [PMID: 38163830 DOI: 10.1007/s12098-023-04992-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
The fact that almost half of the 1 million cases of childhood tuberculosis (TB) globally remain undiagnosed jeopardizes the TB elimination goal. Fortunately, there are new advances in this field which have the potential to bridge this diagnostic gap. Advances in imaging include computer assisted interpretation of chest X-rays (CXRs), point of care ultrasound (POCUS) and faster and superior computed tomography/ magnetic resonance imaging (CT/ MRI) protocols. The urine lipoarabinomannan test has proved to be a good point of care test for diagnosing TB in Human immunodeficiency virus (HIV) infected children. Stool and nasopharyngeal aspirates are emerging as acceptable alternatives for gastric lavage and induced sputum for diagnosing intrathoracic tuberculosis. Xpert MTB/RIF Ultra has improved sensitivity compared to Xpert MTB/RIF for diagnosing both pulmonary/ extrapulmonary TB. Xpert XDR is another commercially available accurate point of care test for detecting resistance to drugs other than rifampicin in smear positive samples. Other molecular methods including new line probe assays, pyrosequencing, whole genome sequencing, and targeted next generation sequencing are extremely promising but not available commercially at present. The C-Tb skin test is an acceptable alternative to the tuberculin skin test and interferon gamma release assays for diagnosis of latent infection. There is an urgent need to incorporate some of these advances in the existing diagnostic algorithms of childhood TB.
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Affiliation(s)
- Camilla Rodrigues
- Department of Microbiology & Infection Prevention Control, Hinduja Hospital, Mahim, Mumbai, India
| | - Tanu Singhal
- Department of Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
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Moore BK, Graham SM, Nandakumar S, Doyle J, Maloney SA. Pediatric Tuberculosis: A Review of Evidence-Based Best Practices for Clinicians and Health Care Providers. Pathogens 2024; 13:467. [PMID: 38921765 PMCID: PMC11206390 DOI: 10.3390/pathogens13060467] [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: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Advances in pediatric TB care are promising, the result of decades of advocacy, operational and clinical trials research, and political will by national and local TB programs in high-burden countries. However, implementation challenges remain in linking policy to practice and scaling up innovations for prevention, diagnosis, and treatment of TB in children, especially in resource-limited settings. There is both need and opportunity to strengthen clinician confidence in making a TB diagnosis and managing the various manifestations of TB in children, which can facilitate the translation of evidence to action and expand access to new tools and strategies to address TB in this population. This review aims to summarize existing guidance and best practices for clinicians and health care providers in low-resource, TB-endemic settings and identify resources with more detailed and actionable information for decision-making along the clinical cascade to prevent, find, and cure TB in children.
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Affiliation(s)
- Brittany K. Moore
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Stephen M. Graham
- Centre for International Child Health, Department of Pediatrics, University of Melbourne, Melbourne 3052, Australia;
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne 3052, Australia
- International Union Against Tuberculosis and Lung Disease, 75001 Paris, France
| | - Subhadra Nandakumar
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Joshua Doyle
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
| | - Susan A. Maloney
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.N.); (J.D.); (S.A.M.)
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Munyangaju I, José B, Esmail R, Palmer M, Santiago B, Hernanz-Lobo A, Mutemba C, Perez P, Tlhapi LH, Mudaly V, Pitcher RD, Jahnen A, Carruana EV, López-Varela E, Thierry-Chef I. Evaluation of radiological capacity and usage in paediatric TB diagnosis: A mixed-method protocol of a comparative study in Mozambique, South Africa and Spain. PLoS One 2024; 19:e0299293. [PMID: 38635846 PMCID: PMC11025952 DOI: 10.1371/journal.pone.0299293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Tuberculosis remains one of the top ten causes of mortality globally. Children accounted for 12% of all TB cases and 18% of all TB deaths in 2022. Paediatric TB is difficult to diagnose with conventional laboratory tests, and chest radiographs remain crucial. However, in low-and middle-income countries with high TB burden, the capacity for radiological diagnosis of paediatric TB is rarely documented and data on the associated radiation exposure limited. METHODS A multicentre, mixed-methods study is proposed in three countries, Mozambique, South Africa and Spain. At the national level, official registry databases will be utilised to retrospectively compile an inventory of licensed imaging resources (mainly X-ray and Computed Tomography (CT) scan equipment) for the year 2021. At the selected health facility level, three descriptive cross-sectional standardised surveys will be conducted to assess radiology capacity, radiological imaging diagnostic use for paediatric TB diagnosis, and radiation protection optimization: a site survey, a clinician-targeted survey, and a radiology staff-targeted survey, respectively. At the patient level, potential dose optimisation will be assessed for children under 16 years of age who were diagnosed and treated for TB in selected sites in each country. For this component, a retrospective analysis of dosimetry will be performed on TB and radiology data routinely collected at the respective sites. National inventory data will be presented as the number of units per million people by modality, region and country. Descriptive analyses will be conducted on survey data, including the demographic, clinical and programmatic characteristics of children treated for TB who had imaging examinations (chest X-ray (CXR) and/or CT scan). Dose exposure analysis will be performed by children's age, gender and disease spectrum. DISCUSSION As far as we know, this is the first multicentre and multi-national study to compare radiological capacity, radiation protection optimization and practices between high and low TB burden settings in the context of childhood TB management. The planned comparative analyses will inform policy-makers of existing radiological capacity and deficiencies, allowing better resource prioritisation. It will inform clinicians and radiologists on best practices and means to optimise the use of radiological technology in paediatric TB management.
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Affiliation(s)
- Isabelle Munyangaju
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Benedita José
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Ridwaan Esmail
- Imaging Division, Ministry of Health, Maputo, Mozambique
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Begoña Santiago
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
| | - Alicia Hernanz-Lobo
- Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Crimenia Mutemba
- National Tuberculosis Control Program, Ministry of Health, Maputo, Mozambique
| | - Patricia Perez
- National Paediatric TB Working Group, Maputo, Mozambique
| | | | - Vanessa Mudaly
- Service Priorities Coordination (SPC) Directorate, Department of Health, Western Cape, South Africa
| | - Richard D. Pitcher
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andreas Jahnen
- ITIS Department, Luxembourg Institute of Science and Technology, Luxembourg
| | - Eliseo Vañó Carruana
- Department of Radiology, Faculty of Medicine of the Complutense University, Madrid, Spain
| | - Elisa López-Varela
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health, Barcelona, Catalonia, Spain
- Medicine and Translational Research Department, University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Wobudeya E, Nanfuka M, Ton Nu Nguyet MH, Taguebue JV, Moh R, Breton G, Khosa C, Borand L, Mwanga-Amumpaire J, Mustapha A, Nolna SK, Komena E, Mugisha JR, Natukunda N, Dim B, de Lauzanne A, Cumbe S, Balestre E, Poublan J, Lounnas M, Ngu E, Joshi B, Norval PY, Terquiem EL, Turyahabwe S, Foray L, Sidibé S, Albert KK, Manhiça I, Sekadde M, Detjen A, Verkuijl S, Mao TE, Orne-Gliemann J, Bonnet M, Marcy O. Effect of decentralising childhood tuberculosis diagnosis to primary health centre versus district hospital levels on disease detection in children from six high tuberculosis incidence countries: an operational research, pre-post intervention study. EClinicalMedicine 2024; 70:102527. [PMID: 38685921 PMCID: PMC11056389 DOI: 10.1016/j.eclinm.2024.102527] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/02/2024] Open
Abstract
Background Childhood tuberculosis (TB) remains underdiagnosed largely because of limited awareness and poor access to all or any of specimen collection, molecular testing, clinical evaluation, and chest radiography at low levels of care. Decentralising childhood TB diagnostics to district hospitals (DH) and primary health centres (PHC) could improve case detection. Methods We conducted an operational research study using a pre-post intervention cross-sectional study design in 12 DHs and 47 PHCs of 12 districts across Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included 1) a comprehensive diagnosis package at patient-level with tuberculosis screening for all sick children and young adolescents <15 years, and clinical evaluation, Xpert Ultra-testing on respiratory and stool samples, and chest radiography for children with presumptive TB, and 2) two decentralisation approaches (PHC-focused or DH-focused) to which districts were randomly allocated at country level. We collected aggregated and individual data. We compared the proportion of tuberculosis detection in children and young adolescents <15 years pre-intervention (01 August 2018-30 November 2019) versus during intervention (07 March 2020-30 September 2021), overall and by decentralisation approach. This study is registered with ClinicalTrials.gov, NCT04038632. Findings TB was diagnosed in 217/255,512 (0.08%) children and young adolescent <15 years attending care pre-intervention versus 411/179,581 (0.23%) during intervention, (OR: 3.59 [95% CI 1.99-6.46], p-value<0.0001; p-value = 0.055 after correcting for over-dispersion). In DH-focused districts, TB diagnosis was 80/122,570 (0.07%) versus 302/86,186 (0.35%) (OR: 4.07 [1.86-8.90]; p-value = 0.0005; p-value = 0.12 after correcting for over-dispersion); and 137/132,942 (0.10%) versus 109/93,395 (0.11%) in PHC-focused districts, respectively (OR: 2.92 [1.25-6.81; p-value = 0.013; p-value = 0.26 after correcting for over-dispersion). Interpretation Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant. Funding source Unitaid, Grant number 2017-15-UBx-TB-SPEED.
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Affiliation(s)
- Eric Wobudeya
- MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda
| | - Mastula Nanfuka
- MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda
| | - Minh Huyen Ton Nu Nguyet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | | | - Raoul Moh
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouët Boigny University, Abidjan, Cote d'Ivoire
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d’Ivoire
| | | | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Laurence Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | | | - Eric Komena
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d’Ivoire
| | | | | | - Bunnet Dim
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Eric Balestre
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | - Julien Poublan
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | - Manon Lounnas
- University of Montpellier, IRD, CNRS, MIVEGEC, Montpellier, France
| | - Eden Ngu
- Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Basant Joshi
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | - Pierre-Yves Norval
- Technical Assistance for Management/Soutien Pneumologique International, France
| | | | | | | | | | | | | | | | | | - Sabine Verkuijl
- World Health Organization; Global Tuberculosis Programme, Geneva, Switzerland
| | | | - Joanna Orne-Gliemann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | - Maryline Bonnet
- TransVIHMI, University of Montpellier, IRD/INSERM, Montpellier, France
| | - Olivier Marcy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
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d’Elbée M, Harker M, Mafirakureva N, Nanfuka M, Huyen Ton Nu Nguyet M, Taguebue JV, Moh R, Khosa C, Mustapha A, Mwanga-Amumpere J, Borand L, Nolna SK, Komena E, Cumbe S, Mugisha J, Natukunda N, Mao TE, Wittwer J, Bénard A, Bernard T, Sohn H, Bonnet M, Wobudeya E, Marcy O, Dodd PJ. Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study. EClinicalMedicine 2024; 70:102528. [PMID: 38685930 PMCID: PMC11056392 DOI: 10.1016/j.eclinm.2024.102528] [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: 09/26/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 05/02/2024] Open
Abstract
Background The burden of childhood tuberculosis remains high globally, largely due to under-diagnosis. Decentralising childhood tuberculosis diagnosis services to lower health system levels could improve case detection, but there is little empirically based evidence on cost-effectiveness or budget impact. Methods In this mathematical modelling study, we assessed the cost-effectiveness and budget impact of decentralising a comprehensive diagnosis package for childhood tuberculosis to district hospitals (DH-focused) or primary health centres (PHC-focused) compared to standard of care (SOC). The project was conducted in Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda between August 1st, 2018 and September 30th, 2021. A mathematical model was developed to assess the health and economic outcomes of the intervention from a health system perspective. Estimated outcomes were tuberculosis cases, deaths, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs). We also calculated the budget impact of nationwide implementation. The TB-Speed Decentralization study is registered with ClinicalTrials.gov, NCT04038632. Findings For the DH-focused strategy versus SOC, ICERs ranged between $263 (Cambodia) and $342 (Côte d'Ivoire) per DALY averted. For the PHC-focused strategy versus SOC, ICERs ranged between $477 (Cambodia) and $599 (Côte d'Ivoire) per DALY averted. Results were sensitive to TB prevalence and the discount rate used. The additional costs of implementing the DH-focused strategy ranged between $12.8 M (range 10.8-16.4) (Cambodia) and $50.4 M (36.5-74.4) (Mozambique), and between $13.9 M (12.6-15.6) (Sierra Leone) and $134.6 M (127.1-143.0) (Uganda) for the PHC-focused strategy. Interpretation The DH-focused strategy may be cost-effective in some countries, depending on the cost-effectiveness threshold used for policy making. Either intervention would require substantial early investment. Funding Unitaid.
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Affiliation(s)
- Marc d’Elbée
- University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
- Ceped UMR 196, Université Paris Cité, Research Institute for Sustainable Development (IRD), Inserm, Paris, France
| | - Martin Harker
- TB Modelling Group, TB Centre, and Global Centre for Health Economics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Mastula Nanfuka
- MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda
| | - Minh Huyen Ton Nu Nguyet
- University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | | | - Raoul Moh
- Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Félix-Houphouët Boigny University, Abidjan, Côte d’Ivoire
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | - Laurence Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Eric Komena
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d’Ivoire
| | | | | | | | | | - Jérôme Wittwer
- University of Bordeaux, National Institute for Health and Medical Research UMR 1219, Bordeaux, France
| | - Antoine Bénard
- CHU Bordeaux, Service d'information Médicale, USMR & CIC-EC 14-01, Bordeaux, France
| | | | - Hojoon Sohn
- Seoul National University College of Medicine, Seoul, South Korea
| | - Maryline Bonnet
- TransVIHMI, University of Montpellier, IRD /INSERM, Montpellier, France
| | - Eric Wobudeya
- MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda
| | - Olivier Marcy
- University of Bordeaux, National Institute for Health and Medical Research (Inserm) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France
| | - Peter J. Dodd
- School of Health & Related Research, University of Sheffield, Sheffield, United Kingdom
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Boccard V, Corvol F, Prévost B, Corvol H. Disseminated tuberculosis in a migrant child. BMJ Case Rep 2024; 17:e259295. [PMID: 38378592 PMCID: PMC10882297 DOI: 10.1136/bcr-2023-259295] [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] [Indexed: 02/22/2024] Open
Abstract
Tuberculosis (TB) poses a major global health threat, substantially affecting children, who contribute notably to new cases and deaths. Diagnosing TB in kids is challenging due to collection issues and the paucibacillary nature of the disease. Disseminated TB, uncommon in children in low TB incidence countries, remains a significant cause of morbidity in migrant populations. We illustrate a rare case of disseminated TB in a middle-childhood boy who migrated from Angola to France, displaying chronic cough, fatigue, weight loss and persistent fever. Investigations revealed widespread TB affecting several organs (lungs, heart, bones and lymph nodes). Prompt diagnosis led to a treatment regimen of four antibiotics (isoniazid, rifampin, pyrazinamide, ethambutol) and corticosteroids, resulting in substantial improvement after 2 months. Subsequent treatment involved two antibiotics (isoniazid and rifampin) for 10 more months. This case underscores the criticality of early identification and comprehensive treatment for disseminated TB, ensuring improved outcomes and reduced risks.
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Affiliation(s)
- Victorine Boccard
- Pediatric Pulmonology Department, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Paris, France
| | - Fany Corvol
- Pediatric Pulmonology Department, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Paris, France
| | - Blandine Prévost
- Pediatric Pulmonology Department, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Paris, France
| | - Harriet Corvol
- Pediatric Pulmonology Department, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Paris, France
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Lemaire JF, Cohn J, Kakayeva S, Tchounga B, Ekouévi PF, Ilunga VK, Ochieng Yara D, Lanje S, Bhamu Y, Haule L, Namubiru M, Nyamundaya T, Berset M, de Souza M, Machekano R, Casenghi M. Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002865. [PMID: 38315700 PMCID: PMC10843113 DOI: 10.1371/journal.pgph.0002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
In 2022, an estimated 1.25 million children <15 years of age developed tuberculosis (TB) worldwide, but >50% remained undiagnosed or unreported. WHO recently recommended integrated and decentralized models of care as an approach to improve access to TB services for children, but evidence remains limited. The Catalyzing Paediatric TB Innovation project (CaP-TB) implemented a multi-pronged intervention to improve TB case finding in children in nine sub-Saharan African countries. The intervention introduced systematic TB screening in different facility-based child-health entry-points, decentralisation of TB diagnosis and management, improved sample collection with access to Xpert® MTB/RIF or MTB/RIF Ultra testing, and implementation of contact investigation. Pre-intervention records were compared with those during intervention to assess effect on paediatric TB cascade of care. The intervention screened 1 991 401 children <15 years of age for TB across 144 health care facilities. The monthly paediatric TB case detection rate increased significantly during intervention versus pre-intervention (+46.0%, 95% CI 36.2-55.8%; p<0.0001), with variability across countries. The increase was greater in the <5 years old compared to the 5-14 years old (+53.4%, 95% CI 35.2-71.9%; p<0.0001 versus +39.9%, 95% CI 27.6-52.2%; p<0.0001). Relative contribution of lower-tier facilities to total case detection rate increased from 37% (71.8/191.8) pre-intervention to 50% (139.9/280.2) during intervention. The majority (89.5%) of children with TB were identified through facility-based intensified case-finding and primarily accessed care through outpatient and inpatient departments. In this multi-country study implemented under real-life conditions, the implementation of integrated and decentralized interventions increased paediatric TB case detection. The increase was driven by lower-tier facilities that serve as the primary point of healthcare contact for most patients. The effect was greater in children < 5 years compared to 5-14 years old, representing an important achievement as the TB detection gap is higher in this subpopulation. (Study number NCT03948698).
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Affiliation(s)
| | - Jennifer Cohn
- Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shirin Kakayeva
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Vicky Kambaji Ilunga
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, République Démocratique du Congo
| | | | - Samson Lanje
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Yusuf Bhamu
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Leo Haule
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Mary Namubiru
- Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda
| | | | - Maude Berset
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Rhoderick Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
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8
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Melingui BF, Leroy-Terquem E, Palmer M, Taguebue JV, Wachinou AP, Gaudelus J, Salomao A, Bunnet D, Eap TC, Borand L, Chabala C, Khosa C, Moh R, Mwanga-Amumpere J, Eang MT, Manhiça I, Mustapha A, Beneteau S, Falzon L, Seddon JA, Berteloot L, Wobudeya E, Marcy O, Bonnet M, Norval PY. Evaluation of a short training course of chest X-ray interpretation for the diagnosis of paediatric TB. IJTLD OPEN 2024; 1:76-82. [PMID: 38966688 PMCID: PMC11221594 DOI: 10.5588/ijtldopen.23.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 07/06/2024]
Abstract
BACKGROUND Chest X-ray (CXR) interpretation is challenging for the diagnosis of paediatric TB. We assessed the performance of a three half-day CXR training module for healthcare workers (HCWs) at low healthcare levels in six high TB incidence countries. METHODS Within the TB-Speed Decentralization Study, we developed a three half-day training course to identify normal CXR, CXR of good quality and identify six TB-suggestive features. We performed a pre-post training assessment on a pre-defined set of 20 CXR readings. We compared the proportion of correctly interpreted CXRs and the median reading score before and after the training using the McNemar test and a linear mixed model. RESULTS Of 191 HCWs, 43 (23%) were physicians, 103 (54%) nurses, 18 (9.4%) radiology technicians and 12 (6.3%) other professionals. Of 2,840 CXRs with both assessment, respectively 1,843 (64.9%) and 2,277 (80.2%) were correctly interpreted during pre-training and post-training (P < 0.001). The median reading score improved significantly from 13/20 to 16/20 after the training, after adjusting by country, facility and profession (adjusted β = 3.31, 95% CI 2.44-4.47). CONCLUSION Despite some limitations of the course assessment that did not include abnormal non-TB suggestive CXR, study findings suggest that a short CXR training course could improve HCWs' interpretation skills in diagnosing paediatric TB.
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Affiliation(s)
- B F Melingui
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut national de la santé et de la recherche médicale (INSERM) Unité 1175, Montpellier
| | - E Leroy-Terquem
- International Pulmonology Support, François Quesnay Hospital, Mantes-la-Jolie, France
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - J-V Taguebue
- Mother and Child Center, Chantal Biya Foundation, Yaoundé, Cameroon
| | - A P Wachinou
- National Teaching Hospital for Tuberculosis and Pulmonary Diseases, Akpakpa Abokicodji, Cotonou, Benin
| | - J Gaudelus
- Service de Pediatrie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris Seine Saint Denis, Bondy, France
| | - A Salomao
- Independent Public Health Consultant, Maputo, Mozambique
| | - D Bunnet
- Epidemiology and Public Health Unit, Pasteur Institute in Cambodia, Phnom Penh
| | - T C Eap
- National TB Programme, Phnom Penh
| | - L Borand
- Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Chabala
- Children's Hospital, University Teaching Hospital, Lusaka, Zambia
| | - C Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - R Moh
- Programme ANRS Coopération Côte d'Ivoire, Centre hospitalière universitaire de Treichville, Abidjan, Côte d'Ivoire
| | | | - M T Eang
- National Center for Tuberculosis and Leprosy (CENAT/NTP), Ministry of Health, Phnom Penh, Cambodia
| | - I Manhiça
- Programa Nacional de Controlo da Tuberculose, Ministério da Saúde, Maputo, Mozambique
| | - A Mustapha
- Ola During Children Hospital, Freetown, Sierra Leone
| | - S Beneteau
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut national de la santé et de la recherche médicale (INSERM) Unité 1175, Montpellier
| | - L Falzon
- International Pulmonology Support, Paris, France
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Disease, Imperial College London, London, UK
| | - L Berteloot
- Department of Pediatric Radiology, University Hospital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E Wobudeya
- Makerere University-Johns Hopkins University Research Collaboration Care Ltd, Kampala, Uganda
| | - O Marcy
- University of Bordeaux, INSERM Unité mixte de Recherche 1219, IRD Unité Mixte de Recherche 271, Bordeaux
| | - M Bonnet
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut national de la santé et de la recherche médicale (INSERM) Unité 1175, Montpellier
| | - P Y Norval
- Technical Assistance for Management, Paris, France
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9
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Vonasek BJ, Kumwenda T, Gumulira J, Nyirongo M, Heller T, Palmer M, McCollum ED, Chiunda M, Garcia-Prats AJ, Bélard S, Mvalo T. Point-of-Care Ultrasound for Tuberculosis in Young Children with Severe Acute Malnutrition. Pediatr Infect Dis J 2024; 43:e65-e67. [PMID: 37963311 PMCID: PMC11061262 DOI: 10.1097/inf.0000000000004158] [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: 11/16/2023]
Abstract
Point-of-care ultrasound (POCUS) to diagnose tuberculosis (TB) was assessed in 131 children under 5 years old hospitalized with severe acute malnutrition. Of these, 23% had confirmed or unconfirmed TB and 5% were HIV-infected. There were no POCUS findings associated with TB diagnosis. POCUS visualization quality was satisfactory for 65% and examination acceptability was "good" for 52%.
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Affiliation(s)
- Bryan J Vonasek
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Mwawi Nyirongo
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Tom Heller
- Lighthouse Trust, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, Washington
| | - Megan Palmer
- Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Eric D McCollum
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Anthony J Garcia-Prats
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Sabine Bélard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Tisungane Mvalo
- UNC Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Khambati N, Song R, MacLean ELH, Kohli M, Olbrich L, Bijker EM. The diagnostic yield of nasopharyngeal aspirate for pediatric pulmonary tuberculosis: a systematic review and meta-analysis. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:18. [PMID: 38628460 PMCID: PMC11019899 DOI: 10.1186/s44263-023-00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 04/19/2024]
Abstract
Background Tuberculosis (TB) is a leading cause of death in children, but many cases are never diagnosed. Microbiological diagnosis of pulmonary TB is challenging in young children who cannot spontaneously expectorate sputum. Nasopharyngeal aspirates (NPA) may be more easily collected than gastric aspirate and induced sputum and can be obtained on demand, unlike stool. However, further information on its diagnostic yield is needed. Methods We systematically reviewed and meta-analyzed the diagnostic yield of one NPA for testing by either culture or nucleic acid amplification testing (NAAT) to detect Mycobacterium tuberculosis from children. We searched three bibliographic databases and two trial registers up to 24th November 2022. Studies that reported the proportion of children diagnosed by NPA compared to a microbiological reference standard (MRS) were eligible. Culture and/or WHO-endorsed NAAT on at least one respiratory specimen served as the MRS. We also estimated the incremental yield of two NPA samples compared to one and summarized operational aspects of NPA collection and processing. Univariate random-effect meta-analyses were performed to calculate pooled diagnostic yield estimates. Results From 1483 citations, 54 were selected for full-text review, and nine were included. Based on six studies including 256 children with microbiologically confirmed TB, the diagnostic yield of NAAT on one NPA ranged from 31 to 60% (summary estimate 44%, 95% CI 36-51%). From seven studies including 242 children with confirmed TB, the diagnostic yield of culture was 17-88% (summary estimate 58%, 95% CI 42-73%). Testing a second NPA increased the yield by 8-19% for NAAT and 4-35% for culture. NPA collection procedures varied between studies, although most children had NPA successfully obtained (96-100%), with a low rate of indeterminate results (< 5%). Data on NPA acceptability and specifically for children under 5 years were limited. Conclusions NPA is a suitable and feasible specimen for diagnosing pediatric TB. The high rates of successful collection across different levels of healthcare improve access to microbiological testing, supporting its inclusion in diagnostic algorithms for TB, especially if sampling is repeated. Future research into the acceptability of NPA and how to standardize collection to optimize diagnostic yield is needed.
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Affiliation(s)
- Nisreen Khambati
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK
| | - Emily Lai-Ho MacLean
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Centre of Research Excellence in Tuberculosis, Sydney, NSW, Australia
| | - Mikashmi Kohli
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Laura Olbrich
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Fraunhofer Institute ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK
- Department of Pediatrics, Maastricht University Medical Center, MosaKids Children’s Hospital, Maastricht, the Netherlands
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11
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Joshi B, De Lima YV, Massom DM, Kaing S, Banga MF, Kamara ET, Sesay S, Borand L, Taguebue JV, Moh R, Khosa C, Breton G, Mwanga-Amumpaire J, Bonnet M, Wobudeya E, Marcy O, Orne-Gliemann J. Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001525. [PMID: 37819919 PMCID: PMC10566691 DOI: 10.1371/journal.pgph.0001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs' perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020-21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR.
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Affiliation(s)
- Basant Joshi
- National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France
| | | | | | - Sanary Kaing
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | | | | | | | - Laurence Borand
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | | | - Raoul Moh
- Programme PAC-CI, Site de l’ANRS Abidjan, Abidjan, Côte d’Ivoire
| | - Celso Khosa
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | - Maryline Bonnet
- University of Montpellier, IRD,–INSERM, TRANSVIH MI, Montpellier, France
| | - Eric Wobudeya
- MUJHU Research Collaboration, MU-JHU Care Limited, Kampala, Uganda
| | - Olivier Marcy
- National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France
| | - Joanna Orne-Gliemann
- National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France
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12
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Shaikh A, Rodrigues C. What's New in the Molecular Diagnosis of Childhood Tuberculosis? Pediatr Infect Dis J 2023; 42:e377-e379. [PMID: 37463349 DOI: 10.1097/inf.0000000000004044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Ambreen Shaikh
- From the Department of Laboratory Medicine, Section Tuberculosis, Foundation Medical Research, Worli, Mumbai, India
| | - Camilla Rodrigues
- Department of Laboratory Medicine, Section Microbiology, Hinduja Hospital, Mahim, Mumbai, India
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13
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Chiang SS, Graham SM, Schaaf HS, Marais BJ, Sant'Anna CC, Sharma S, Starke JR, Triasih R, Achar J, Amanullah F, Armitage LY, Aurilio RB, Buck WC, Centis R, Chabala C, Cruz AT, Demers AM, du Preez K, Enimil A, Furin J, Garcia-Prats AJ, Gonzalez NE, Hoddinott G, Isaakidis P, Jaganath D, Kabra SK, Kampmann B, Kay A, Kitai I, Lopez-Varela E, Maleche-Obimbo E, Malaspina FM, Velásquez JN, Nuttall JJC, Oliwa JN, Andrade IO, Perez-Velez CM, Rabie H, Seddon JA, Sekadde MP, Shen A, Skrahina A, Soriano-Arandes A, Steenhoff AP, Tebruegge M, Tovar MA, Tsogt B, van der Zalm MM, Welch H, Migliori GB. Clinical standards for drug-susceptible TB in children and adolescents. Int J Tuberc Lung Dis 2023; 27:584-598. [PMID: 37491754 PMCID: PMC10365562 DOI: 10.5588/ijtld.23.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - S M Graham
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Burnet Institute, Melbourne, VIC, Australia
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Department of Paediatrics and Child Health and the Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Department of Infectious Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - C C Sant'Anna
- Department of Paediatrics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Section of Infectious Diseases, Texas Children's Hospital, Houston, TX, USA
| | - R Triasih
- Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, Karachi, Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
| | - L Y Armitage
- Heartland National TB Center, University of Texas Health Science Center at Tyler, San Antonio, TX, USA
| | - R B Aurilio
- Department of Paediatrics, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Department of Paediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - W C Buck
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
| | - C Chabala
- School of Medicine, Department of Paediatrics and Child Health, University of Zambia, Lusaka, Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - A T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - A-M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Division of Microbiology, Department of Laboratory Medicine, CHU Sainte-Justine, Montreal, Canada
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Enimil
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - N E Gonzalez
- División Neumotisiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Dirección General de Posgrado, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - D Jaganath
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kampmann
- Charite Centre for Global Health, Charite Universitatsmedizin Berlin, Berlin, Germany, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A Kay
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - I Kitai
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Lopez-Varela
- Hospital Clínic and ISGlobal, Universitat de Barcelona, Barcelona, Spain, Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - E Maleche-Obimbo
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - F Mestanza Malaspina
- Department of Paediatrics, Hospital San Bartólome, Lima, Red Peruana de Tuberculosis Pediátrica, Dirección de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Perú
| | - J Niederbacher Velásquez
- Department of Paediatrics, Universidad Industrial de Santander, Bucaramanga, Board of Directors, Asociación Colombiana de Neumología Pediátrica, Bogotá, Colombia
| | - J J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - J N Oliwa
- Faculty of Health Sciences, Department of Paediatrics and Child Health, The University of Nairobi, Nairobi, Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - I Orozco Andrade
- Center of Diagnosis and Integral Treatment for Tuberculosis, Servicios Médicos de la Frontera, Juárez, Medical Coordination, Juntos Binational Tuberculosis Project, Juárez, México
| | - C M Perez-Velez
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - H Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Disease, Imperial College London, London, UK
| | - M P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - A Shen
- Beijing Paediatric Research Institute, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, Pediatric Research Institute, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - A Skrahina
- Clinical Department, The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Infection and Immunity in Children, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A P Steenhoff
- Global Health Center and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA, Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Tebruegge
- Department of Infection, Immunity & Inflammation, University College London, Great Ormond Street Institute of Child Health, London, UK, Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - M A Tovar
- Socios En Salud Sucursal Perú, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - B Tsogt
- Research and Innovation, Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Welch
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, Department of Paediatrics, The University of Papua New Guinea School of Medicine and Health Sciences, Port Moresby, Papua New Guinea
| | - G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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14
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Feenstra E, Driesen Y, Moes N, Jouret N, Vanden Driessche K. Disseminated Tuberculosis Mimicking as Crohn's Disease in a Paediatric Patient. Case Rep Infect Dis 2023; 2023:7312630. [PMID: 37425428 PMCID: PMC10325872 DOI: 10.1155/2023/7312630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/04/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Tuberculosis is an important infectious disease for children worldwide. The clinical presentation of tuberculosis in children is diverse and, depending on the affected organs, it is often accompanied with nonspecific symptoms that can mimic other diseases. In this report, we present a case of disseminated tuberculosis in an 11-year-old boy with intestinal followed by pulmonary involvement. The diagnosis was delayed for several weeks due to the clinical picture which was mimicking Crohn's disease, the known difficulties in diagnostic tests and the improvement on meropenem. This case demonstrates the importance of a detailed microscopic examination of gastrointestinal biopsies and the tuberculostatic effect of meropenem which physicians should be aware of.
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Affiliation(s)
- Elizabeth Feenstra
- Paediatric Department, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Yentl Driesen
- Paediatric Department, Ziekenhuisnetwerk Antwerpen (ZNA) Stuivenberg/Jan Palfijn, Antwerp, Belgium
| | - Nicolette Moes
- Paediatric Department, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nathalie Jouret
- Paediatric Department, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Koen Vanden Driessche
- General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital (UZA), Edegem, Belgium
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15
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Quan S, Zou T, Duan L, Tian X, Wang Y, Zhu Y, Fang M, Shi Y, Wan C, Sun L, Shen A. Clinical Characteristics of Pulmonary Tuberculosis in Children Tested by Xpert MTB/RIF Ultra. Pediatr Infect Dis J 2023; 42:389-395. [PMID: 36854100 DOI: 10.1097/inf.0000000000003866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The Xpert MTB/rifampicin Ultra (Xpert Ultra) assay improves the early diagnosis of active tuberculosis (TB) in children. Clinical evaluation is paramount for the interpretation of any positive Xpert Ultra test, especially those with low quantities of DNA. METHODS In this study, 391 children with suspected TB who were tested with Xpert Ultra were enrolled. The clinical characteristics and Xpert Ultra results were further analyzed. RESULTS The sensitivity and specificity of Xpert Ultra were 45.0% (149/331) and 96.7% (58/60), respectively. Children with higher semiquantitative scales of Xpert Ultra showed higher percentages of a positive MTB culture, positive acid-fast bacilli staining, severe type of disease, fever, cough and expectoration, a higher white blood cell count and higher C-reactive protein concentrations (all P < 0.01). Among 44 children with an Xpert Ultra trace result, there were no differences in clinical characteristics between confirmed cases and unconfirmed TB cases. CONCLUSIONS The prevalence of trace is relatively high and can be considered positive in paucibacillary children. Clinical presentations are associated with bacterial load quantified by Xpert Ultra. The interpretation of Xpert Ultra trace results based on clinical information is important for the diagnosis of TB.
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Affiliation(s)
- Shuting Quan
- From the National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Tingting Zou
- Department of Pediatrics Infectious Diseases, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Li Duan
- Department of Pediatrics Infectious Diseases, The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Xue Tian
- From the National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yacui Wang
- From the National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yu Zhu
- Department of Pediatrics Infectious Diseases, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Min Fang
- Department of Pediatrics Infectious Diseases, The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Yan Shi
- Department of Pediatrics Infectious Diseases, The No. 1 People's Hospital of Liangshan Yizu Autonomous Prefecture, Liangshan, China
| | - Chaomin Wan
- Department of Pediatrics Infectious Diseases, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Lin Sun
- From the National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Adong Shen
- From the National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
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Paediatric Multidrug Resistant Tuberculosis Outbreak in a Low Incidence Country: The Need for Better Diagnosic Tools and More Accessible Treatments. Arch Bronconeumol 2023; 59:183-185. [PMID: 36517312 DOI: 10.1016/j.arbres.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
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17
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Graham SM, Marais BJ, Amanullah F. Tuberculosis in Children and Adolescents: Progress and Perseverance. Pathogens 2022; 11:pathogens11040392. [PMID: 35456067 PMCID: PMC9029126 DOI: 10.3390/pathogens11040392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Stephen M. Graham
- Department of Paediatrics and Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- The Burnet Institute, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-405782505
| | - Ben J. Marais
- Department of Paediatrics and Child Health, The Children’s Hospital at Westmead, The University of Sydney, Westmead, NSW 2145, Australia;
| | - Farhana Amanullah
- Department of Paediatrics, The Indus Hospital and Health Network, The Aga Khan University Hospital, Karachi 75500, Pakistan;
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