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Rodríguez-Molino P, González Sánchez A, Noguera-Julián A, Soler-García A, Martínez Paz P, Méndez-Echevarría A, Baquero-Artigao F, González Muñoz M, Ruíz-Serrano MJ, Monsonís M, Sánchez León R, Saavedra-Lozano J, Santiago-García B, Sainz T. QuantiFERON-TB reversion in children and adolescents with tuberculosis. Front Immunol 2024; 15:1310472. [PMID: 38576621 PMCID: PMC10991797 DOI: 10.3389/fimmu.2024.1310472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
We analyzed 136 children with tuberculosis disease or infection and a positive QuantiFERON-TB (QFT) assay, followed-up for a median of 21 months (0.4-11years). QFT reversed in 16.9% of cases, with significant decreases in TB1 (-1.72 vs. -0.03 IU/ml, p=0.001) and TB2 (-1.65 vs. -0.43 IU/ml, p=0.005) levels compared to non-reverters. We found a higher QFT reversion rate among children under 5 years (25.0% vs 11.9%, p=0.042), and those with TST induration <15mm (29% vs 13.3%, p=0.055). Our data reveal that, although QFT test remained positive in the majority of children, reversion occurred in 16% of cases in a progressive and stable pattern. Younger age and reduced TST induration were associated with QFT reversion.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Antoni Noguera-Julián
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Aleix Soler-García
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
| | - Patricia Martínez Paz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
| | - Ana Méndez-Echevarría
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Fernando Baquero-Artigao
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - María Jesús Ruíz-Serrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias - CIBERES, Madrid, Spain
| | - Manuel Monsonís
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rocío Sánchez León
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jesús Saavedra-Lozano
- Infectious Diseases Department, General Pediatrics, Hospital Gregorio Marañón, Madrid, Spain
| | - Begoña Santiago-García
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Infectious Diseases Department, General Pediatrics, Hospital Gregorio Marañón, Madrid, Spain
| | - Talía Sainz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
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Bossacoma Busquets F, Sánchez E, Noguera-Julián A, Villaronga Flaqué M, Fortuny C. Weight-adapted fixed-dose combined adult antiretroviral tablets for HIV-infected children. J Clin Pharm Ther 2021; 46:867-871. [PMID: 33393094 DOI: 10.1111/jcpt.13341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Therapeutic alternatives to simplify antiretroviral therapy (ART) in HIV-infected children are needed. We report our experience with abacavir(ABC)/lamivudine(3TC) individualized dose compounded capsules (IDCC). COMMENT We present a prospective case series of HIV-infected children who did not weigh enough to receive the adult fixed-dose combination including ABC/3TC 600mg/300mg, and were treated with weight-adapted ABC/3TC IDCC in Barcelona, Spain. Thirteen patients (12 girls) received ABC/3TC IDCC for a median(IQR) time of 30(17-54) months. No significant changes were observed in CD4 cell counts, weight or height z-scores over time. Suppression of viral replication was maintained in 7 patients with undetectable viremia at baseline. Another 5 patients achieved viral suppression with ABC/3TC IDCC-based ART, while one non-adherent girl did not. No adverse events related to ABC/3TC IDCC were observed. WHAT IS NEW AND CONCLUSION Despite small numbers, the long-term use of ABC/3TC IDCC was feasible, safe, and effective in the treatment of HIV-infected children.
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Affiliation(s)
| | - Emilia Sánchez
- Blanquerna Ramon Llull University Faculty of Health Sciences, Barcelona, Spain
| | - Antoni Noguera-Julián
- Hospital Sant Joan de Déu, Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Universitat de Barcelona, Pediatria, CIBER, Red de Investigación Translacional en Infectología Pediatrica, RITIP, Barcelona, Spain
| | | | - Clàudia Fortuny
- Hospital Sant Joan de Deu, Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Universitat de Barcelona, Pediatria, Red de Investigación Translacional en Infectología Pediátrica, RITIP, Barcelona, Spain
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Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, Gabrovska N, Velizarova S, Prunk P, Osterman V, Krivec U, Lo Vecchio A, Shingadia D, Soriano-Arandes A, Melendo S, Lanari M, Pierantoni L, Wagner N, L'Huillier AG, Heininger U, Ritz N, Bandi S, Krajcar N, Roglić S, Santos M, Christiaens C, Creuven M, Buonsenso D, Welch SB, Bogyi M, Brinkmann F, Tebruegge M. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. The Lancet Child & Adolescent Health 2020; 4:653-661. [PMID: 32593339 PMCID: PMC7316447 DOI: 10.1016/s2352-4642(20)30177-2] [Citation(s) in RCA: 785] [Impact Index Per Article: 196.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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Affiliation(s)
- Florian Götzinger
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Wilhelminenspital, Vienna, Austria
| | - Begoña Santiago-García
- Department of Paediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Antoni Noguera-Julián
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Miguel Lanaspa
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Laura Lancella
- Academic Department of Paediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Natalia Gabrovska
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Svetlana Velizarova
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Petra Prunk
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Veronika Osterman
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Uros Krivec
- Department of Paediatric Pulmonology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrea Lo Vecchio
- Section of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Delane Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marcello Lanari
- Medical and Surgical Science Department, S Orsola University Hospital, Bologna, Italy
| | - Luca Pierantoni
- Medical and Surgical Science Department, S Orsola University Hospital, Bologna, Italy
| | - Noémie Wagner
- Paediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Paediatric Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland; Department of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Srini Bandi
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Nina Krajcar
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Srđan Roglić
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Mar Santos
- Department of Paediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | | | - Marine Creuven
- Department of Paediatric Infectious Diseases, CHC Montlegia, Liège, Belgium
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Matthias Bogyi
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Wilhelminenspital, Vienna, Austria
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Ruhr University Bochum, Bochum, Germany
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Department of Paediatrics, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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