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Tb in children

James Gaensbauer, Richard Broadhurst
PURPOSE OF REVIEW: Tuberculosis is leading cause of global morbidity and mortality and a significant proportion of the burden of disease occurs in children. In the past 5 years, a number of innovations have improved the diagnosis and treatment for children with both latent tuberculosis infection and active disease. RECENT FINDINGS: This review discusses three key areas of innovation. First, we assess utilization and performance of interferon-gamma release assays (IGRAs) in different clinical and epidemiologic scenarios...
February 15, 2019: Current Infectious Disease Reports
Priyanka Naranje, Ashu Seith Bhalla, Poonam Sherwani
Chest is the commonest site of involvement by tuberculosis (TB) in children; lungs being the most frequently affected region, followed by nodes, pleura and chest wall. It is difficult to diagnose TB in children due to lack of overt symptoms and difficulty in obtaining samples for microbiological confirmation. Hence various imaging modalities play an important role in diagnostic algorithm as well as in follow-up after treatment. Standardization of chest radiograph reporting in context of clinically suspected TB is the need of the hour so as to suggest a proper diagnosis and avoid over-diagnosis...
February 14, 2019: Indian Journal of Pediatrics
Mathias G Holgersen, June K Marthin, Kim G Nielsen
INTRODUCTION: Nasal nitric oxide (nNO) is extremely low in individuals with primary ciliary dyskinesia (PCD) and is recommended as part of early workup. We investigated whether tidal breathing sampling for a few seconds was as discriminative between PCD and healthy controls (HC) as conventional tidal breathing sampling (cTB-nNO) for 20-30 s. METHODS: We performed very rapid sampling of tidal breathing (vrTB-nNO) for 2, 4 and 6 s, respectively. Vacuum sampling with applied negative pressure (vrTB-nNOvac ; negative pressure was applied by pinching the sampling tube) for < 2 s resulted in enhanced suction of nasal air during measurement...
February 14, 2019: Lung
André N H Bulabula, Jenna A Nelson, Eric M Musafiri, Rhoderick Machekano, Nadia A Sam-Agudu, Andreas H Diacon, Maunank Shah, Jacob Creswell, Grant Theron, Robin M Warren, Karen R Jacobson, Jean-Paul Chirambiza, Dieudonné Kalumuna, Bertin C Bisimwa, Patrick D M C Katoto, Michel K Kaswa, Freddy M Birembano, Liliane Kitete, Martin P Grobusch, Zacharie M Kashongwe, Jean B Nachega
Background: Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. Methods: of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017...
February 13, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
M K Khan, M N Islam, J Ferdous, M M Alam
Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. Tuberculosis in human is mostly by Mycobacterium tuberculosis and primarily affects lungs causing pulmonary tuberculosis. It can also affect intestine, meninges, bones, joints, lymph nodes, skin and other tissues of the body causing extra-pulmonary tuberculosis. Human TB is transmitted mainly through droplet infection and droplet nuclei. Infection of human with M...
January 2019: Mymensingh Medical Journal: MMJ
Isha Saini, Aparna Mukherjee, Hitender Gautam, Mohit Singla, K R Jat, Rakesh Lodha, Urvashi B Singh, S K Kabra
OBJECTIVE: To evaluate utility of Xpert MTB/RIF in bronchoalveolar lavage fluid in children with probable pulmonary tuberculosis. METHODS: Children with probable pulmonary tuberculosis with negative smear and Xpert on induced sputum/gastric aspirate were subjected to bronchoalveolar lavage (BAL) for Xpert assay and mycobacterial liquid culture. Data of children <14 y undergoing bronchoscopy for suspected MDR-TB (n=12) were also analyzed. The sensitivity of Xpert in BAL fluid for diagnosis of probable and confirmed pulmonary tuberculosis was calculated with clinico-radiological diagnosis and culture as gold standards, respectively...
December 15, 2018: Indian Pediatrics
Agam Jain, Rakesh Lodha
Tuberculosis (TB), once widely prevalent throughout the world, experienced falling incidence rates in early twentieth century in developed nations, even before the introduction of anti-TB drugs, attributed to improved hygiene and living conditions. Active TB may develop following fresh infection or activation of latent tuberculosis infection (LTBI). LTBI is a state of persistent bacterial viability, however, the host stays asymptomatic and there is no evidence of clinically active tuberculosis. Therefore, treatment of all LTBI is considered as one of the ways to control tuberculosis...
February 11, 2019: Indian Journal of Pediatrics
Dora Correia, Dario Terribilini, Stefan Zepter, Alessia Pica, Nicola Bizzocchi, Werner Volken, Sonja Stieb, Frank Ahlhelm, Evelyn Herrmann, Michael K Fix, Peter Manser, Daniel M Aebersold, Damien C Weber
Background: Whole-ventricular radiotherapy (WV-RT) followed by a boost to the tumor bed (WV-RT/TB) is recommended for intracranial germ cell tumors (IGCT). As the critical brain areas are mainly in the target volume vicinity, it is unclear if protons indeed substantially spare neurofunctional organs at risk (NOAR). Therefore, a dosimetric comparison study of WV-RT/TB was conducted to assess whether proton or photon radiotherapy achieves better NOAR sparing. Methods: Eleven children with GCT received 24 Gy(RBE) WV-RT and a boost up to 40 Gy(RBE) in 25 fractions of 1...
February 2019: Clinical and Translational Radiation Oncology
Silvia S Chiang, Sangshin Park, Emily I White, Jennifer F Friedman, Andrea T Cruz, Hernán Del Castillo, Leonid Lecca, Mercedes C Becerra, James A Seddon
Background: International guidelines recommend monitoring weight as an indicator of therapeutic response in childhood tuberculosis (TB) disease. This recommendation is based on observations in adults. In the current study, we evaluated the association between weight change and treatment outcome, the accuracy of using weight change to predict regimen efficacy, and whether successfully treated children achieve catch-up weight gain. Methods: We enrolled children treated for drug-susceptible TB disease (group 1) and multidrug-resistant TB disease (group 2) in Peru...
February 1, 2019: Journal of the Pediatric Infectious Diseases Society
Gerald Mboowa, Savannah Mwesigwa, Eric Katagirya, Gaone Retshabile, Busisiwe C Mlotshwa, Lesedi Williams, Adeodata Kekitiinwa, David Kateete, Eddie Wampande, Misaki Wayengera, Betty Nsangi Kintu, Grace P Kisitu, Samuel Kyobe, Chester W Brown, Neil A Hanchard, Graeme Mardon, Moses Joloba, Gabriel Anabwani, Ed Pettitt, Masego Tsimako-Johnstone, Ishmael Kasvosve, Koketso Maplanka, Sununguko W Mpoloka, Makhosazana Hlatshwayo, Mogomotsi Matshaba
Background : The Human Heredity and Health in Africa consortium (H3Africa) was conceived to facilitate the application of genomics technologies to improve health across Africa. Here, we describe how the Collaborative African Genomics Network ( CAfGEN) of the H3Africa consortium is using genomics to probe host genetic factors important to the progression of HIV and HIV-tuberculosis (TB) coinfection in sub-Saharan Africa.          Methods : CAfGEN is an H3Africa collaborative centre comprising expertise from the University of Botswana; Makerere University; Baylor College of Medicine Children's Clinical Centers of Excellence (COEs) in Botswana, Uganda, and Swaziland; as well as Baylor College of Medicine, Texas...
April 18, 2018: AAS open research
Ben J Marais
Children suffer a huge and often an unrecognized burden of tuberculosis (TB) in endemic countries like India. Better data have improved the visibility of childhood TB, but the establishment of functional TB prevention and treatment programs for children remains challenging. Barriers to TB prevention include: 1) non-implementation of existing guidelines, 2) perceived inability to rule out active TB with fear of creating drug resistance and 3) limited local guidance on the use of preventive therapy after close contact with drug resistant TB...
February 1, 2019: Indian Journal of Pediatrics
Roopali Rajput, Paras Singh, Rohit Sarin, Prabhpreet Sethi, Sangeeta Sharma
BACKGROUND: Confirmatory diagnosis of extra-pulmonary tuberculosis remains a true challenge owing to difficulty in procuring appropriate specimen, inefficient laboratory methods and paucibacillary nature of infection. These obstructions become all the very difficult in pediatric EPTB cases, due to non-specific clinical signs and symptoms, low sensitivity of smear microscopy and culture, lack of awareness among clinicians, etc. AIM OF THE STUDY: The present study aimed to evaluate the diagnostic accuracy of rapid and cost-effective loop-mediated isothermal amplification (LAMP) assay for EPTB diagnosis in children...
January 28, 2019: Journal of Microbiological Methods
Tao Li, Hemant Deepak Shewade, Kyaw Thu Soe, Jeanette J Rainey, Hui Zhang, Xin Du, Lixia Wang
OBJECTIVE: The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China. DESIGN: A retrospective inventory study (record review). SETTING: Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: Under-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis...
January 28, 2019: BMJ Open
Madeeha Laghari, Syed Azhar Syed Sulaiman, Amer Hayat Khan, Naheed Memon
BACKGROUND: Understanding the explanations behind unsuccessful treatment outcomes in tuberculosis (TB) patients is important to improve treatment success. Treatment completion for TB is the mainstay of TB prevention and control. The study was aimed to assess the treatment outcomes and predictors for unsuccessful outcomes among children with TB. METHODS: This was a prospective multicenter study conducted in Sindh. Children aged ≤14 years enrolled from June to November 2016 were included...
January 24, 2019: BMC Infectious Diseases
Alexander W Kay, Andrew R DiNardo, Qiniso Dlamini, Jaqueline Kahari, Temhlanga Mndzebele, Godwin Mtetwa, Pilar Ustero, Gugu Maphalala, Anna M Mandalakas
Interferon-gamma release assays are increasingly used in children to establish evidence of tuberculosis (TB) infection and to assist in the diagnosis of TB disease. The QuantiFERON-TB Gold In-Tube assay is being phased out in favor of a next-generation test, the QuantiFERON-TB Gold Plus (QFT-Plus) assay. The QFT-Plus assay is designed with two antigen tubes to differentially stimulate CD4+ and CD8+ T cells. The performance of this assay has been documented extensively in adults but has not yet been evaluated in children...
January 21, 2019: American Journal of Tropical Medicine and Hygiene
A S Yasseen, E Rea, M M Hirji, C Yang, G G Alvarez, K Khan, I Kitai
BACKGROUND: There are few data on the utility of screening paediatric immigrants for tuberculosis (TB) in low TB burden countries. OBJECTIVE: To evaluate the utility of the Canadian immigration medical examination and TB Medical Surveillance (TBMS) for detecting paediatric TB disease. DESIGN: A 10-year population-based retrospective cohort study of foreign-born children (ages 0-10 years) and adolescents (ages 11-17 years) immigrating to Ontario, Canada, using linked immigration and public health databases...
January 1, 2019: International Journal of Tuberculosis and Lung Disease
Anthony J Garcia-Prats, Susan E Purchase, Muhammad Osman, Heather R Draper, H Simon Schaaf, Lubbe Wiesner, Paolo Denti, Anneke C Hesseling
This study characterized the pharmacokinetics of novel 100 mg levofloxacin dispersible tablets in 24 children aged <5 years with household MDR-TB exposure. Data was pooled with previously published data from children (n=109) with MDR-TB receiving adult (250 mg) levofloxacin tablets, using nonlinear mixed-effects modelling. The adult 250 mg tablets had 41% lower bioavailability compared to the novel dispersible tablets, resulting in much higher exposures with the dispersible tablets with the same mg/kg dose...
January 22, 2019: Antimicrobial Agents and Chemotherapy
Yijie Guo, Yuan Zhou, Siqi Yan, Chengjuan Qu, Liyun Wang, Xiong Guo, Jing Han
The objective of this study is to investigate changes in the expression of enzymes involved in chondroitin sulfate (CS) sulfation in distal articular surface of proximal interphalangeal joint isolated from school-age children patients with Kashin-Beck disease (KBD), using normal children as controls. Articular cartilage samples were collected from four normal and four KBD children (7-12 years old), and these children were assigned to control and KBD groups. Hematoxylin and eosin (H&E), toluidine blue (TB), and immunohistochemical (IHC) stainings were utilized to evaluate changes in joint pathology and expression of enzymes involved in CS sulfation, including carbohydrate sulfotransferase 12 (CHST-12), carbohydrate sulfotransferase 13 (CHST-13), and uronyl 2-O-sulfotransferase (UST)...
January 19, 2019: Biological Trace Element Research
H Simon Schaaf
Approximately 25,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, but few of them are diagnosed and appropriately treated for MDR-TB. New diagnostic tools have improved our ability to diagnose children with bacteriologically confirmed TB earlier. However, the majority of childhood TB cases are not bacteriologically confirmed; therefore a high index of suspicion is needed, and taking a detailed history of contact with drug-resistant source cases and previous TB treatment is important to identify presumed MDR-TB cases...
January 17, 2019: Indian Journal of Pediatrics
Jennifer Furin
Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from January 1, 1996 up to October 31, 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevention of DR-TB, and support to achieve the best possible outcomes...
January 16, 2019: Expert Review of Respiratory Medicine
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