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Lima LDM, Fonseca AR, Sant'Anna CC, Parente AAAI, Aurilio RB, Sant'Anna MDFBP. Tuberculosis among children and adolescents with rheumatic diseases - case series. Pediatr Rheumatol Online J 2023; 21:136. [PMID: 37950309 PMCID: PMC10636992 DOI: 10.1186/s12969-023-00918-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Rheumatic patients have a higher frequency of tuberculosis(TB) than the general population. This study aimed to describe children and adolescents with TB and rheumatic diseases(RD) who were being treated in a reference center. METHODS A series of TB cases were investigated in a reference center for childhood TB in Rio de Janeiro, Brazil, from 1995 to 2022. RESULTS Fifteen patients with underlying RD and TB were included with 8(53%) being female. The mean age at RD diagnosis was 7.10years (SD ± 0,57 years), and the mean age at TB diagnosis was 9.81 years(SD ± 0.88 years). A total of 9 cases of pulmonary TB(PTB) and 6 cases of extrapulmonary TB-pleural(2), joint/osteoarticular(1), cutaneous(1), ocular(1), and peritoneal(1)- were described. The RD observed in the 15 patients included juvenile idiopathic arthritis(9), juvenile systemic lupus erythematosus(3), juvenile dermatomyositis(1), polyarteritis nodosa(1), and pyoderma gangrenosum(1). Among the immunosuppressants/immunobiologics, methotrexate(8) was the most commonly used, followed by corticosteroids(6), etanercept(2), mycophenolate mofetil(1), cyclosporine A(1), adalimumab(1), and tocilizumab(1). The most common symptoms were fever and weight loss, and a predominance of PTB cases was noted. GeneXpert MTB/RIF® was performed in six patients and was detectable in two without rifampicin resistance; Xpert Ultra® was performed in five patients, and traces with indeterminate rifampicin resistance were detected in three. One female patient discontinued treatment, and another passed away. CONCLUSIONS The case series demonstrated the importance of suspecting and investigating TB in RD affected patients who are using immunosuppressants/ immunobiologics, particularly in countries with high rates of TB such as Brazil.
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Affiliation(s)
- Lenita de Melo Lima
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil.
| | - Adriana Rodrigues Fonseca
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
- Pediatric Rheumatology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
| | - Clemax Couto Sant'Anna
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
| | - Ana Alice Amaral Ibiapina Parente
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
| | - Rafaela Baroni Aurilio
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
| | - Maria de Fátima Bazhuni Pombo Sant'Anna
- Pediatric Pulmonology Unit, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50 - Cidade Universitária, Rio de Janeiro, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lima LDM, Aurilio RB, Fonseca AR, Parente AAAI, Sant’Anna MDFBP, Sant’Anna CC. Tuberculosis in children and adolescents with rheumatic diseases using biologic agents: an integrative review. Rev Paul Pediatr 2023; 42:e2022084. [PMID: 37436237 PMCID: PMC10332438 DOI: 10.1590/1984-0462/2024/42/2022084] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy. DATA SOURCE An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: (["tuberculosis"] AND (["children"] OR ["adolescent"]) AND ["rheumatic diseases"] AND (["tumor necrosis factor-alpha"] OR ["etanercept"] OR ["adalimumab"] OR ["infliximab"] OR ["biological drugs"] OR ["rituximab"] OR ["belimumab"] OR ["tocilizumab"] OR ["canakinumab"] OR ["golimumab"] OR ["secukinumab"] OR ["ustekinumab"] OR ["tofacitinib"] OR ["baricitinib"] OR ["anakinra"] OR ["rilonacept"] OR ["abatacept"]), between January 2010 and October 2021. DATA SYNTHESIS Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death. CONCLUSIONS The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease.
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Affiliation(s)
- Lenita de Melo Lima
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | | | - Adriana Rodrigues Fonseca
- Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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4
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Gunasekera KS, Marcy O, Muñoz J, Lopez-Varela E, Sekadde MP, Franke MF, Bonnet M, Ahmed S, Amanullah F, Anwar A, Augusto O, Aurilio RB, Banu S, Batool I, Brands A, Cain KP, Carratalá-Castro L, Caws M, Click ES, Cranmer LM, García-Basteiro AL, Hesseling AC, Huynh J, Kabir S, Lecca L, Mandalakas A, Mavhunga F, Myint AA, Myo K, Nampijja D, Nicol MP, Orikiriza P, Palmer M, Sant'Anna CC, Siddiqui SA, Smith JP, Song R, Thuong Thuong NT, Ung V, van der Zalm MM, Verkuijl S, Viney K, Walters EG, Warren JL, Zar HJ, Marais BJ, Graham SM, Debray TPA, Cohen T, Seddon JA. Development of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis. Lancet Child Adolesc Health 2023; 7:336-346. [PMID: 36924781 PMCID: PMC10127218 DOI: 10.1016/s2352-4642(23)00004-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Many children with pulmonary tuberculosis remain undiagnosed and untreated with related high morbidity and mortality. Recent advances in childhood tuberculosis algorithm development have incorporated prediction modelling, but studies so far have been small and localised, with limited generalisability. We aimed to evaluate the performance of currently used diagnostic algorithms and to use prediction modelling to develop evidence-based algorithms to assist in tuberculosis treatment decision making for children presenting to primary health-care centres. METHODS For this meta-analysis, we identified individual participant data from a WHO public call for data on the management of tuberculosis in children and adolescents and referral from childhood tuberculosis experts. We included studies that prospectively recruited consecutive participants younger than 10 years attending health-care centres in countries with a high tuberculosis incidence for clinical evaluation of pulmonary tuberculosis. We collated individual participant data including clinical, bacteriological, and radiological information and a standardised reference classification of pulmonary tuberculosis. Using this dataset, we first retrospectively evaluated the performance of several existing treatment-decision algorithms. We then used the data to develop two multivariable prediction models that included features used in clinical evaluation of pulmonary tuberculosis-one with chest x-ray features and one without-and we investigated each model's generalisability using internal-external cross-validation. The parameter coefficient estimates of the two models were scaled into two scoring systems to classify tuberculosis with a prespecified sensitivity target. The two scoring systems were used to develop two pragmatic, treatment-decision algorithms for use in primary health-care settings. FINDINGS Of 4718 children from 13 studies from 12 countries, 1811 (38·4%) were classified as having pulmonary tuberculosis: 541 (29·9%) bacteriologically confirmed and 1270 (70·1%) unconfirmed. Existing treatment-decision algorithms had highly variable diagnostic performance. The scoring system derived from the prediction model that included clinical features and features from chest x-ray had a combined sensitivity of 0·86 [95% CI 0·68-0·94] and specificity of 0·37 [0·15-0·66] against a composite reference standard. The scoring system derived from the model that included only clinical features had a combined sensitivity of 0·84 [95% CI 0·66-0·93] and specificity of 0·30 [0·13-0·56] against a composite reference standard. The scoring system from each model was placed after triage steps, including assessment of illness acuity and risk of poor tuberculosis-related outcomes, to develop treatment-decision algorithms. INTERPRETATION We adopted an evidence-based approach to develop pragmatic algorithms to guide tuberculosis treatment decisions in children, irrespective of the resources locally available. This approach will empower health workers in primary health-care settings with high tuberculosis incidence and limited resources to initiate tuberculosis treatment in children to improve access to care and reduce tuberculosis-related mortality. These algorithms have been included in the operational handbook accompanying the latest WHO guidelines on the management of tuberculosis in children and adolescents. Future prospective evaluation of algorithms, including those developed in this work, is necessary to investigate clinical performance. FUNDING WHO, US National Institutes of Health.
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Affiliation(s)
- Kenneth S Gunasekera
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
| | - Olivier Marcy
- Inserm UMR1219, Institut de Recherche pour le Développement EMR 271, GHiGS, University of Bordeaux, Bordeaux, France
| | - Johanna Muñoz
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Elisa Lopez-Varela
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maryline Bonnet
- University of Montpellier, TransVIHMI, Institut de Recherche pour le Développement, Inserm, Montpellier, France; Epicentre, Mbarara, Uganda
| | - Shakil Ahmed
- Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Farhana Amanullah
- Indus Hospital & Health Network, Karachi, Pakistan; The Aga Khan University Hospital, Karachi, Pakistan
| | - Aliya Anwar
- Indus Hospital & Health Network, Karachi, Pakistan
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Rafaela Baroni Aurilio
- Instituto de Puericultura e Pediatria Martagao Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sayera Banu
- Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Iraj Batool
- Indus Hospital & Health Network, Karachi, Pakistan
| | | | - Kevin P Cain
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucía Carratalá-Castro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Birat Nepal Medical Trust, Lazmipat, Kathmandu, Nepal
| | - Eleanor S Click
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa M Cranmer
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Julie Huynh
- Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Senjuti Kabir
- Programme on Emerging Infections, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Socios En Salud Surcursal Perú, Lima, Perú
| | - Anna Mandalakas
- Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Clinical Infectious Disease Group, German Center for Infectious Research, Clinical TB Unit, Research Center Borstel, Borstel, Germany
| | | | - Aye Aye Myint
- Department of Paediatrics, University of Medicine, Mandalay, Myanmar
| | - Kyaw Myo
- Department of Paediatrics, University of Medicine, Magway, Myanmar
| | - Dorah Nampijja
- Department of Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark P Nicol
- Division of Infection and Immunity, Department of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Patrick Orikiriza
- Epicentre, Mbarara, Uganda; Department of Microbiology, Division of Basic Medical Sciences, School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Sara Ahmed Siddiqui
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Indus Hospital & Health Network, Karachi, Pakistan
| | - Jonathan P Smith
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rinn Song
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vibol Ung
- University of Health Sciences, Phnom Penh, Cambodia; National Pediatric Hospital, Phnom Penh, Cambodia
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Kerri Viney
- Global Tuberculosis Programme, WHO, Geneva, Switzerland; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Elisabetta G Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Directorate of Integrated Laboratory Medicine, Institute of Human Genetics, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ben J Marais
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen M Graham
- Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Infectious Diseases, Imperial College London, London, UK
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do Nascimento Maia P, Bazhuni Pombo Sant'Anna MDF, Parente AAAI, Baroni Aurilio R, Albino Servilha Silva B, Luiz RR, Sant'Anna CC. Correlation of digital flow peak with spirometry in children with and without asthma. J Asthma 2023; 60:270-276. [PMID: 35188448 DOI: 10.1080/02770903.2022.2045308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Spirometry and peak expiratory flow measurement (PEF) are combined during functional respiratory assessments. The new digital peak flow meter (DPM) evaluates the forced expiratory volume in the first second (FEV1) and PEF. OBJECTIVE To compare lung function measurements using spirometry and DPM. METHODS This cross-sectional analytical study assessed FEV1 and PEF in children with and without asthma. Statistical analysis was performed to assess the agreement between the measures using the intraclass correlation coefficient (ICC), Bland-Altman, and survival agreement plot. RESULTS 125 (3-12 y) and 196 (6-18 y) children without and with asthma, respectively, were studied. In children without asthma, the ICC for FEV1 and PEF were 0.89 and 0.86, respectively, while the corresponding values were 0.87 and 0.79, respectively, in patients with asthma. The Bland-Altman method showed a difference of -0.4 to 0.5 for FEV1 in patients without asthma, with a tendency to increase as the FEV1 increased to a certain extent. In patients with asthma, the pattern was similar for FEV1, and the PEF had a greater dispersion than among those without asthma; however, a good agreement pattern was maintained. In the survival agreement plot, when accepting a tolerance of 0.150 mL for FEV1, there was an agreement of close to 55% in both groups. Likewise, when accepting a tolerance of 0.5 L/s for PEF, an agreement of close to 60% and 50% was observed in patients without and with asthma, respectively. CONCLUSION DPM was effective as a measure of lung function in pediatric patients with and without asthma.
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Affiliation(s)
- Paula do Nascimento Maia
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
| | | | - Ana Alice Amaral Ibiapina Parente
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
| | - Rafaela Baroni Aurilio
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
| | - Beatriz Albino Servilha Silva
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
| | - Clemax Couto Sant'Anna
- Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira, pediatric pneumology, Rio de Janeiro, Brazil
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Cardoso CAA, Rossoni AMDO, Rezende JMD, Aurilio RB, Santos RJFLD, Ferrarini MAG, Kritski AL, Martin A, Sant'Anna CC. String test: a potentially useful tool in the diagnosis of pulmonary tuberculosis in Brazilian children and adolescents. Rev Inst Med Trop Sao Paulo 2022; 64:e27. [PMID: 35384958 PMCID: PMC8993147 DOI: 10.1590/s1678-9946202264027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
This study investigated the potential use of the String Test (ST) for the
diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. This is a
case series of patients aged 4-15 years presenting with clinically presumed PTB
and submitted to ST in three pediatric TB referral centers in Brazil, between
November 2017 and July 2020. The ST was performed in the morning, after 4-12 h
of fasting, followed by ingestion of the capsule by the patient, which was
attached to the patient’s malar region. The material was collected for
simultaneous smear microscopy (acid-fast bacilli - AFB),
culture and the molecular investigation by the GeneXpert MTB/RIF®.
Thirty-three patients with presumed PTB were included and ST was performed in 26
(78.8%) of them and 7 (21.2%) patients could not swallow the cord. The diagnosis
of PTB was established in 11 (42.3%) of the 26 patients who underwent the ST.
The diagnosis of PTB was confirmed (by culture or GeneXpert MTB/RIF®)
in 5 patients, 4 of whom were also positive by the ST. Two of them showed
positivity by the GeneXpert MTB/RIF® only in the ST sample. Two other
patients had a positive ST following the induced sputum test (AFB, GeneXpert
MTB/RIF®, and positive culture in both specimens). Thus, ST was
positive in 36.4% of the patients in whom PTB was diagnosed. ST could be a
useful test for diagnosing PTB in children and adolescents.
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Affiliation(s)
| | | | - Joana Moraes de Rezende
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafaela Baroni Aurilio
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Afranio Lineu Kritski
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anandi Martin
- Ghent University, Department of Biochemistry and Microbiology, Laboratory of Microbiology, Ghent, Belgium
| | - Clemax Couto Sant'Anna
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, Rio de Janeiro, Brazil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro, Brazil
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Aurilio RB, Ferreira S, Parente AAAI, Sant’Anna MDFP, Pereira CS, Malaquias TDSS, Kritski AL, Sant’Anna CC. Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis in children and adolescents. Rev Inst Med Trop Sao Paulo 2022; 64:e12. [PMID: 35170713 PMCID: PMC8845440 DOI: 10.1590/s1678-9946202264012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
This prospective study describes the use of Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis (EPTB) in children and adolescents, in Rio de Janeiro, Brazil. Eighteen patients were studied; the final diagnosis of EPTB was established in 13 (72%). Gene-Xpert Ultra results showed detection in 10/13 (77%) of EPTB cases (7 of these 10 with trace-positive results). Gene-Xpert Ultra proved to be a promising method for the diagnosis of childhood EPTB.
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Carvalho RF, Carvalho ACC, Velarde LGC, Rossoni AMDO, Aurilio RB, Sias SMDA, Schmidt CM, Moreira ADSR, Martins PDS, Gonçalves LI, Martire TM, Barbosa APF, Santos APQD, Romanelli RMDC, Oliveira MDGRD, Diniz LMO, Carvalho ALD, Lucena SC, Cruz MLS, Saavedra MC, Tahan TT, Rodrigues CDO, Kritski AL, Sant'Anna CC, Cardoso CAA, Sant'Anna MDFBP. Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system. Rev Inst Med Trop Sao Paulo 2020; 62:e81. [PMID: 33146310 PMCID: PMC7608063 DOI: 10.1590/s1678-9946202062081] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pedro da Silva Martins
- Instituto Oswaldo Cruz , Fundação Oswaldo Cruz , Rio de Janeiro , Rio de Janeiro , Brazil
| | | | | | | | | | | | | | | | | | - Sheila Cunha Lucena
- Hospital Municipal Raphael de Paula Souza , Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Mariza Curto Saavedra
- Hospital Federal dos Servidores do Estado , Rio de Janeiro , Rio de Janeiro , Brazil
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Aurilio RB, Marsili VV, Malaquias TDSS, Kritski AL, Sant'Anna CC. The use of Gene-Xpert MTB RIF in the diagnosis of extrapulmonary tuberculosis in childhood and adolescence. Rev Soc Bras Med Trop 2020; 53:e20200104. [PMID: 33027414 PMCID: PMC7534970 DOI: 10.1590/0037-8682-0104-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gene-Xpert MTB RIF (Xpert) is based on nucleic acid amplification by real-time polymerase chain reaction, which allows for the identification of Mycobacterium tuberculosis and rifampin resistance. We describe the use of Xpert for extrapulmonary tuberculosis (EPTB) in children and adolescents. METHODS A case series of two reference centers in Rio de Janeiro from 2014-2019. RESULTS The final diagnosis of EPTB was established in 11/36 (31%) patients, with five cases detectable by Xpert. For lymph node evaluation (9/11), diagnosis by Xpert occurred in 5/9 patients, all with caseous aspects. CONCLUSIONS Xpert can facilitate the rapid diagnosis of lymph node tuberculosis.
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Affiliation(s)
- Rafaela Baroni Aurilio
- Instituto de Pediatria e Puericultura Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Vivian Vidal Marsili
- Instituto de Pediatria e Puericultura Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Afrânio Lineu Kritski
- Programa Acadêmico de Tuberculose, Instituto de Doenças do Tórax, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Clemax Couto Sant'Anna
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Aurilio RB, Luiz RR, Land MGP, Cardoso CAA, Kritski AL, Sant'Anna CC. The clinical and molecular diagnosis of childhood and adolescent pulmonary tuberculosis in referral centers. Rev Soc Bras Med Trop 2020; 53:e20200205. [PMID: 32997050 PMCID: PMC7523522 DOI: 10.1590/0037-8682-0205-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/26/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION: The diagnostic accuracy of Xpert MTB/RIF (Xpert) in pulmonary tuberculosis
(PTB) in children is lower than in adults. In Brazil, the diagnosis of PTB
is based on a diagnostic score system (DSS). This study aims to study the
role of Xpert in children and adolescents with PTB symptoms. METHODS: A cross-sectional study was conducted in 3 referral centers to TB. Children and
adolescents (0-19 years old) whose respiratory samples were submitted to
Xpert were included. Statistical analysis (bivariate and logistic
regression) to assess the simultaneous influence of TB-related variables on
the occurrence of Xpert detectable in TB cases was done. To evaluate the
agreement or disagreement between Xpert results with acid-fast bacillus
(AFB) and cultures, κ method was used (significancy level of 5%). RESULTS: Eighty-eight patients were included in the study and PTB occurred in 43
patients (49%) and Xpert was detectable in 21 patients (24%). Adolescents
and positive culture results were independent predictive variables of Xpert
positivity. DSS sensitivity compared with the final diagnosis of TB was 100%
(95% CI, 88.1-100%), specificity was 97.2% (95% CI, 85.5-99.9%). The
accuracy of the method was 98.5% (95% CI, 91.7-99.9%). CONCLUSIONS: Xpert contributed to diagnosis in 9% of patients with AFB and in culture
negative cases. DSS indicated relevance for this diagnostic approach of
intrathoracic TB (ITB) in reference centers for presenting data both with
high sensitivity and specificity.
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Affiliation(s)
- Rafaela Baroni Aurilio
- Universidade Federal do Rio de Janeiro, Departamento de Pediatria da Faculdade de Medicina, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de Janeiro, Instituto de Estudos de Saúde Coletiva, Rio de Janeiro, RJ, Brasil
| | - Marcelo Gerardin Poirot Land
- Universidade Federal do Rio de Janeiro, Departamento de Pediatria da Faculdade de Medicina, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brasil
| | | | - Afrânio Lineu Kritski
- Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose da Faculdade de Medicina, Instituto de Doenças do Tórax/Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Clemax Couto Sant'Anna
- Universidade Federal do Rio de Janeiro, Departamento de Pediatria da Faculdade de Medicina, Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brasil
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Carvalho ACC, da Silva Martins P, Cardoso CAA, Miceli AL, Martire T, Sant'Anna MDFBP, Schmidt CM, Vieira LM, de Azevedo Sias SM, Quintanilha AP, Barbosa AP, Moreira ADSR, Lara CFDS, Isidoro-Gonçalves L, Aurilio RB, de Alcantara SAG, Bezerra AL, Saderi L, Sotgiu G, Migliori GB, Kritski AL, Sant'Anna CC. Pediatric tuberculosis in the metropolitan area of Rio de Janeiro. Int J Infect Dis 2020; 98:299-304. [PMID: 32599280 DOI: 10.1016/j.ijid.2020.06.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022] Open
Abstract
AIM To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. METHODS This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. RESULTS A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). CONCLUSIONS Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.
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Affiliation(s)
- Anna Cristina C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil; Programa Acadêmico de Tuberculose, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), RJ, Brazil.
| | - Pedro da Silva Martins
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Ana Lúcia Miceli
- Centro Municipal de Saúde de Duque de Caxias, Secretaria Municipal de Saúde de Duque de Caxias, Duque de Caxias, RJ, Brazil
| | - Terezinha Martire
- Faculdade de Medicina, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Maria de Fátima B Pombo Sant'Anna
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Luiza Martins Vieira
- Centro Municipal de Saúde de Duque de Caxias, Secretaria Municipal de Saúde de Duque de Caxias, Duque de Caxias, RJ, Brazil
| | | | | | - Ana Paula Barbosa
- Programa de Controle da Tuberculose do Município de São Gonçalo, São Gonçalo, RJ, Brazil
| | | | | | - Lorrayne Isidoro-Gonçalves
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Rafaela Baroni Aurilio
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - André Luis Bezerra
- Programa Acadêmico de Tuberculose, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), RJ, Brazil
| | - Laura Saderi
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Blizard Institute, Queen Mary University of London, United Kingdom
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), RJ, Brazil
| | - Clemax Couto Sant'Anna
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Aurilio RB, Sant'Anna CC, March MDFBP. CLINICAL PROFILE OF CHILDREN WITH AND WITHOUT COMORBIDITIES HOSPITALIZED WITH COMMUNITY-ACQUIRED PNEUMONIA. Rev Paul Pediatr 2020; 38:e2018333. [PMID: 32401948 PMCID: PMC7212558 DOI: 10.1590/1984-0462/2020/38/2018333] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/20/2019] [Indexed: 11/22/2022]
Abstract
Objective: To describe the clinical profile of children and adolescents hospitalized
with community-acquired pneumonia (CAP). They were divided into two groups:
those with and those without comorbidities. Methods: An observational, cross-sectional, descriptive study with prospective data
collection, was carried out in a cohort of patients aged zero to 11, who
were hospitalized with a clinical and radiological diagnosis of
community-acquired pneumonia, from January 2010 to January 2012. As an
exploratory study, the two groups were compared through logistic regression
for possible risk factors associated with community-acquired pneumonia.
Relative risk (RR) was used with a 95% confidence interval (95%CI). The
process of selection for independent variables was stepwise forward, with a
significance level of 5%. Results: There were 121 cases of community-acquired pneumonia evaluated, and 47.9%
had comorbidities. In the bivariate analysis, patients with comorbidities
demonstrated higher chances for: age >60 months (p=0.005), malnutrition
(p=0.002), previous use of antibiotics (p=0.008) and previous
hospitalization for community-acquired pneumonia in the last 24 months
(p=0.004). In the multivariate analysis, these variables were independent
predictors of community-acquired pneumonia in patients with the
comorbidities: age >60 months (p=0.002; RR=5.39; 95%CI 1.89-15.40);
malnutrition (p=0.008; RR=1.75; 95%CI 1.75-44.60); previous use of
antibiotics (p=0.0013; RR=3.03; 95%CI 1.27-7.20); and previous
hospitalization for community-acquired pneumonia (p=0.035; RR=2.91; 95%CI
1.08-7.90). Conclusions: Most patients with community-acquired pneumonia and comorbidities were aged
>60 months, were malnourished, had used antibiotics and had been
hospitalized for community-acquired pneumonia. Comorbidities were associated
with a higher chance of malnutrition and hospitalizations for
community-acquired pneumonia in an older age group, compared to children
without comorbidities. Knowledge of this clinical profile may contribute to
better assist pediatric patients with community-acquired pneumonia
hospitalized in referral centers.
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Bazhuni Pombo March MDF, Couto Sant Anna C, Baroni Aurilio R, Andrade T, Kritskia A, Malaquias T. Clinical-laboratory profile of children and adolescents who performed the Rapid molecular-TB test (TRM-TB) in Rio de Janeiro. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sant'Anna CC, Horta AA, Tura MTR, March MDFBP, Ferreira S, Aurilio RB, Vieira DB. [Idiopathic pulmonary hemosiderosis treated with azathioprine in a child]. J Bras Pneumol 2008; 33:743-6. [PMID: 18200377 DOI: 10.1590/s1806-37132007000600020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 10/24/2006] [Indexed: 11/22/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH), the main cause of pulmonary hemosiderosis in children, is characterized by intermittent alveolar bleeding and hemosiderin-laden macrophages in sputum and in gastric lavage. The treatment is based on corticosteroids and cytotoxic drugs, under special conditions. We describe the case of a 7-year-old girl with IPH who achieved partial clinical remission with high doses of corticosteroids. However, the treatment had to be discontinued because the patient developed Cushing's syndrome. Treatment was started with an azathioprine-corticosteroid combination and then changed to azathioprine alone, which was maintained for four years, with excellent results.
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Affiliation(s)
- Clemax Couto Sant'Anna
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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