Magnitude of tuberculosis and its associated factors among under-five children admitted with severe acute malnutrition to public hospitals in the city of Dire Dawa, Eastern Ethiopia, 2021: multi-center cross-sectional study

OBJECTIVE

The aim of this study was to assess the prevalence of tuberculosis (TB) and its associated factors among children under 5 years of age with severe acute malnutrition.

METHODS

A multi-center, institution-based, retrospective cross-sectional study was conducted at public hospitals in Dire Dawa City Administration, Eastern Ethiopia from January 1, 2018 to December 30, 2020. A binary logistic regression model was fitted to identify factors associated with the prevalence of TB.

RESULTS

The overall prevalence of TB among children under 5 years of age admitted with severe acute malnutrition to public hospitals in the city of Dire Dawa, Eastern Ethiopia was 10.39% (95% confidence interval (CI) 7.61-13.73%). Repeated admission (adjusted odds ratio (AOR) 2.5, 95% CI 1.08-6.07), a TB contact history (AOR 3.58, 95% CI 1.21-10.6), pneumonia (AOR 2.8, 95% CI 1.29-6.23), stage IV HIV/AIDS (AOR 4.41, 95% CI 1.29-15.13), and being immunized (AOR 0.19, 95% CI 0.08-0.43) were variables significantly associated with the prevalence of TB.

CONCLUSIONS

The results of this study showed that the prevalence of TB among under-five children with severe acute malnutrition was high. The prevalence of TB was associated with having HIV/AIDS, having pneumonia, having a TB contact history, admission status, and immunization status. Integrated TB prevention and screening strategies with nutritional rehabilitation care should be implemented.

Effect of adjusted cut-offs of interferon-γ release assays on diagnosis of tuberculosis in patients with fever of unknown origin

Background

Tuberculosis (TB) is a leading cause of fever of unknown origin (FUO). In recent years, interferon-γ release assays (IGRAs) have been widely utilized and the cut-off values given by the manufacturers are set in countries where rates of TB are not as high.

Methods

A prospective cohort study was conducted in a Chinese general hospital to evaluate the diagnostic performance of T-SPOT.TB (T-SPOT) and QuantiFERON-TB Gold (QFT) in detecting active TB (ATB) in a high TB endemic area. Test results were compared with the culture and clinically confirmed diagnosis. Further, we explored an alternative method of interpreting IGRAs by increasing the cut-off values.

Results

The sensitivity and specificity of T-SPOT in detecting ATB were 85.3% (95% CI 81.6–94.0%) and 71.8% (95% CI 67.3–76.0%), respectively. The sensitivity and specificity of QFT were 72.3% (95% CI 62.8–80.1%) and 77.0% (95% CI 72.7–80.8%), respectively. Receiver operating characteristic analysis was used for evaluation of different cut-off values. When the cut-off values were adjusted as 125 spot-forming cells (SFCs)/ 2.5*10⁵ cells for T-SPOT and 4.0 IU/ml for QFT, the specificity could be improved to > 90.0% (90.3% and 94.1%, respectively), and the sensitivity were 43.1% and 41.6%, respectively. The new adjusted cut-off values were validated in another independent validation cohort.

Conclusion

The adjusted cut-off values of the two assays considerably improved the diagnostic value when applied to FUO patients in clinical settings.

IL-12Rβ1 deficiency corresponding to concurrency of two diseases, mendelian susceptibility to mycobacterial disease and Crohn's disease

Background

The interleukin-12 receptor β1 (IL-12Rβ1) deficiency is a primary immunodeficiency (PID), affecting the immunological pathway of interleukin 12/interferon- γ (IL12/IFN-γ) axis and interleukin 23 receptor (IL23R). Defect in this pathway is mainly affecting the cellular immunity-related disorders. IL-12Rβ1 is a receptor chain of both the IL-12 and the IL-23 receptors and thus, deficiency of IL-12Rβ1 abolishes both IL-12 and IL-23 signaling.

Material and methods

In this study, we performed whole exon sequencing and confirmatory Sanger sequencing in IL-12Rβ1. Evaluation of the IL12/IFN-γ axis was performed by assessment of patients’ whole blood cell to IL12/IFN-γ responding. Total and surface IL-12Rβ1expression was evaluated, in peripheral blood mononuclear cells (PBMCs) and T cell- derived PBMCs, and Th17 count was assessed.

Results

In the present study, we described a c.1791 + 2T > G mutation at a splicing site position in IL-12Rβ1, using whole exome sequencing, and confirmed with targeted Sanger sequencing in a 26- year-old patient with Mendelian susceptibility to mycobacterial disease (MSMD) and Crohn's disease (CD). Complete lack of IL-12Rβ1 protein expression was detected in patient's PBMCs, compared to the healthy control. Furthermore, no IL-12Rβ1 protein was expressed on the cell surface. Interestingly, IL-12Rβ1-mutant cells showed an impaired response to IL12, and Bacillus Calmette–Guérin stimulation, confirming that the mutation is causative in this patient.

Conclusion

A 3′splicing site mutation in IL12Rβ1, can be corresponding to the abolished expression of IL12Rβ1 in patients' cells, and associated with an impaired IL12-mediated signaling, which may lead not only to MSMD, but also to inflammatory bowel disease (IBD).

Intradermal vaccination using the novel microneedle device MicronJet600: Past, present, and future

Intradermal immunization has become a forefront of vaccine improvement, both scientifically and commercially. Newer technologies are being developed to address the need to reduce the dose required for vaccination and to improve the reliability and ease of injection, which have been major hurdles in expanding the number of approved vaccines using this route of administration. In this review, 7 y of clinical experience with a novel intradermal delivery device, the MicronJet600, which is a registered hollow microneedle that simplifies the delivery of liquid vaccines, are summarized. This device has demonstrated both significant dose-sparing and superior immunogenicity in various vaccine categories, as well as in diverse subject populations and age groups. These studies have shown that intradermal delivery using this device is safe, effective, and preferred by the subjects. Comparison with other intradermal devices and potential new applications for intradermal delivery that could be pursued in the future are also discussed.