Tuberculosis In Adolescents Research Articles

How could we have better vaccines against tuberculosis?

Background: Tuberculosis (TB), an infirmity that mainly affects the respiratory system, is the world's second deadliest infectious disease, with > 9 million new cases diagnosed in 2006. One-third of the world's population is now infected with the TB bacillus. According to the WHO, an estimated 1.7 million people died from TB in 2006. More precisely, every 15 seconds, one person dies due to TB worldwide. Objective: To review some of the key advances in the field of TB immunology and to discuss potential means for the development of new generation vaccines against TB disease. Methods: Systematic review of the published literature in various journals. Results/conclusion: The current TB vaccine Bacillus Calmette–Guérin, developed > 85 years ago, reduces the risk of severe forms of TB in early childhood but is not very effective in preventing pulmonary TB in adolescents and adults, the populations with the highest rates of TB disease. TB is changing and evolving, making the development of new vaccines more crucial to controlling the pandemic. Rigorous research using cutting edge vaccine technology is occurring worldwide to combat TB, and various vaccination strategies, especially prime–boost, have been pursued by many scientists.

Corticosteroids in the Treatment of Tuberculous Pleural Effusion in Children: Report of One Case

Pleural effusion is a common feature of primary pulmonary tuberculosis (TB) in adolescents and adults rather than in young children. Multiple studies in adult support the use of corticosteroids as adjuvant therapy to provide a prompt relief of the symptoms， to hasten absorption of fluid, and to prevent long-term pleural sequela. However, the experience in children is rare. We report a 9 year-old girl of tuberculous pleural effusion who responsed well after receiving the combined regimen of corticosteroids-antituberculous therapy.

Tuberculosis in Adolescents: A French Retrospective Study of 52 Cases

Tuberculosis in Adolescents: A French Retrospective Study of 52 Cases

Tuberculosis in Children and Adolescents, Taiwan, 1996–2003

Analysis of data from Taiwan’s National Tuberculosis (TB) Registry showed that incidence of TB in persons <20 years of age was 9.61/100,000 person-years, biphasic, and age-relevant, with a major peak in persons slightly >12 years. Aboriginal children were 8.1–17.4× more likely to have TB than non-Aboriginal children.

ACTIVE TUBERCULOSIS AMONG ADOLESCENTS IN TORONTO, CANADA

There are few studies on tuberculosis (TB) in adolescents. During a 6-year period, 23 adolescents were treated for TB in our center. Most were foreign born. The average time from symptom onset to final diagnosis was 5.2 months. Multifocal and extra pulmonary disease occurred in the majority of patients. Clinicians need greater awareness of the unique features of adolescent TB.

Three cases of pulmonary and/or intestinal tuberculosis in adolescents

Since the tuberculosis (TB) in adolescents has unique clinical characteristics, special attention should be paid to this age group. Adolescents are more susceptible to developing TB disease and more likely to have cavitary pulmonary disease. Also, adolescent patients with TB more frequently present with extrapulmonary disease. We report three adolescents with active pulmonary and/or intestinal TB: one had pulmonary and intestinal TB, another had a pulmonary TB, and the third exclusively had an intestinal TB. Diagnosis was confirmed by pathologic examination of the lung and/or intestines. All three patients were treated successfully without complication. A brief review of the literature has been included.

Cutaneous tuberculosis in children and adolescents: a clinicohistological study

Resurgence of tuberculosis (TB) in the era of human immunodeficiency virus (HIV) has rejuvenated the interest in this global health problem. Cutaneous TB, an important extra-pulmonary form in children, is commonly seen in our dermatological practice. As detection of acid-fast bacillus (AFB) on smear or culture is not always positive, histopathology is necessary to help in diagnosing and classifying the variants of skin TB. The current study was conducted to analyse the clinicopathological characteristics of cutaneous TB in children and adolescents. This prospective study included 103 patients (age<19 years). A detailed history and clinical examination was followed by complete investigative work up including fine needle aspiration cytology and culture. Histopathological evaluation was performed specifically noting the epidermal and dermal features. The patients were followed up regularly for one year after the start of treatment. The different patterns of cutaneous TB seen were, scrofuloderma 38 (36.9%), lichen scrofulosorum 34 (33%), lupus vulgaris 22 (21.3%), TB verrucosa cutis 4 (3.9%), papulonecrotic tuberculid 4 (3.9%) and erythema nodosum 3 (2.9%). Systemic associations were seen in 55 (53.4%) patients, namely TB lymphadenitis in 30 (29.2%), pulmonary TB in 13 (12.6%), abdominal TB in 6 (5.8%) and TB arthritis in 6 (5.8%). The histopathological corroboration of clinical diagnosis was seen in 65.7% of cases of scrofulodermas, 72.7% of cases of lupus vulgaris and 67.6% of cases of lichen scrofulosorum. A large spectrum of clinical patterns and histological characteristics of cutaneous TB exists in children. Lichen scrofulosorum is more commonly seen in comparison to adults. Systemic involvement was a feature in a major proportion of our patients.

Tuberculosis in Adolescents

The only available data about tuberculosis (TB) among adolescents date back to the 1980s, although the incidence of tuberculosis has been increasing in this age group. Medical records were reviewed for all adolescents aged 12 to 18 years hospitalized with the diagnosis of TB in Avicenne/Jean Verdier Teaching hospital (Seine-Saint-Denis, suburb of Paris) between September 2000 and December 2004. Of the 52 patients identified, 52% were female. Median age at diagnosis was 15 years (range, 12-18 years). The proportion of adolescents known to be born abroad was 90%. Diagnoses resulted from the examination of a sick child in 79% of cases, a case contact investigation of an adult suspected of having TB in 19% and routine tuberculin skin test in 2%. Twenty-seven of 52 patients (52%) had isolated pulmonary disease. Sixteen patients (31%) had pulmonary and extrapulmonary TB and 8 cases (17%) had exclusively extrapulmonary disease. The site of extrapulmonary TB included pleural (n = 8), meningitis (n = 4), lymph node (n = 4), peritoneal (n = 5), osteoarticular (n = 3) and genitourinary (n = 1). TB was confirmed by the isolation of Mycobacterium tuberculosis from sputum (n = 21), gastric aspirate (n = 8), bone (n = 1) or cerebrospinal fluid (n = 2). No case had a relapse or recurrence of disease in median 3.2 years of follow up. Our results indicate that demographic and clinical characteristics of adolescents with TB differed from adults and children. A specific approach to the prevention and treatment of TB in adolescents is absolutely necessary.

BCG revaccination does not confer additional protection against tuberculosis (TB) in children and adolescents,

BCG revaccination does not confer additional protection against tuberculosis (TB) in children and adolescents,

Possibility of genetic-based prognosis of pulmonary tuberculosis in adolescents

Possibility of genetic-based prognosis of pulmonary tuberculosis in adolescents

Comparative analysis of tuberculosis incidence during childhood and adolescence in 1993 and 1997 in Paraíba Valley, State of São Paulo (Brazil)

OBJECTIVE: To describe and to compare the incidence of tuberculosis in childhood and adolescence in the Paraíba Valley (State of São Paulo, Brazil) in 1993 and 1997. METHOD: Descriptive study with secondary records obtained from the Tuberculosis Division of the Health Department of the State of São Paulo (Divisão de Tuberculose da Secretaria de Saúde de São Paulo). The variables were the type of case, age, form of detection, diagnosis confirmation, clinical presentation, X-ray results, and anti-HIV test results. RESULTS: The global incidence of tuberculosis in all age ranges was of 97.3 cases/100,000 inhabitants in 1993, and 127.6 cases/100,000 inhabitants in 1997. In the age group up to 15 years old, there were 93 new cases in 1993, and 68 new cases in 1997, representing an incidence of 11.7 cases/100,000 inhabitants in 1993 and 7.9 cases/100,000 inhabitants in 1997. The most common clinical presentation was the pulmonary form; the most important form of detection was by searching communicants; the most frequent diagnosis confirmation was by X-ray, and there was an increasing number of anti-HIV tests between 1993 and 1997. The distribution by age range was similar to the literature data in both years analyzed. CONCLUSION: The values of tuberculosis incidence in childhood and adolescence found in this study are higher than those existing in developed countries.

Clinical and radiological analysis of children and adolescents with tuberculosis in Bahia, Brazil.

We reviewed the clinical and radiological characteristics of tuberculosis (TB) in children and adolescents at the Hospital Especializado Octávio Mangabeira, (HEOM) in Salvador, Bahia. This study included 275 TB patients aged 1 to 15 years seen between January 1990 and November 2001. Standardized forms were filled out on the basis of a review of patient records and x-rays. Through a retrospective and descriptive analysis, it was found that 51.6% were male, 35.3% were aged 1 to 5 years, 28% were aged 6 to 10 and 36.7% were aged 11 to 15. Among all patients, 79.6% lived in the city of Salvador. A history of contact with TB was found in 63.9%, most frequently among children under 5 years old; 77.2% were vaccinated with Bacillus Calmette-Guerin (BCG). The most frequently observed symptoms were coughing (76%), fever (73.1%) weight loss (53.1%), and 4.7% were asymptomatic. Pulmonary TB was most frequent (57.8%) and extra-pulmonary TB occurred in 24.4%, with a predominance of hilar adenopathy. Both forms occurred simultaneously in 17.8%. In 53.1% of the cases the diagnosis was not determined by bacteriology or pathological anatomy; in these cases diagnosis was reached through clinical and radiological criteria, contact history, a tuberculin test > or = 10mm and a positive response to tuberculostatic drugs.

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

This study evaluated the clinical characteristics of childhood and adolescent tuberculosis (TB) at the end of the twentieth century in a referral children's hospital in northern Taiwan. The hospital charts were reviewed retrospectively of children/adolescents aged less than 18 y who were seen in a children's hospital in northern Taiwan between 1994 and 1999 and diagnosed with TB. A total of 62 individuals was diagnosed during this period. The patients' demographic data, presenting symptoms, clinical features, bacteriological results, drug susceptibility and tuberculin skin-test results were analysed. Most diagnosed cases lay in one of two main age ranges, younger than 5 y and adolescents. The presenting symptoms of study subjects were typically non-specific. Bone involvement occurred for 21 patients (33.9%) and was the most common extrapulmonary manifestation. Mycobacterium tuberculosis was isolated from 47 patients (75.8%). Five isolates were resistant to pyrazinamide, three to streptomycin and one to isoniazid, but no multidrug resistant isolates of TB were detected from culture-proven cases. Seventeen of 47 (36.2%) culture-proven patients revealed negative acid-fast staining initially but, subsequently, M. tuberculosis was isolated from various clinical specimens using a standard method at a later date. The tuberculin skin test was positive for 24 of 32 patients (75%) who received such an examination. Extrathoracic TB was more common in children below 5 y of age than their adolescent counterparts, and chiefly involved the peripheral long bones. The potential drug resistance of M. tuberculosis in childhood and adolescent TB did not appear to have been a major problem in northern Taiwan before the year 2000.

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999

The clinical and radiological features of tuberculosis in adolescents

This retrospective review of clinical records and chest radiographs (CR) of adolescents aged 10-18 years was designed to determine age and sex differences in the clinical and radiological features of adolescent tuberculosis (TB). Records of adolescents who were admitted to Brooklyn Hospital for Chest Diseases (BCH) or who were treated at local authority health clinics were screened. Data from 324 adolescents (male:female ratio 1:1.2) were studied. Intra-thoracic lesions were present on CR in 306 (94%). Primary TB with mediastinal adenopathy was present in 32 (10%). Cavitation was present in 180 (56%), 16% at 10 and 73% at 18 years of age. Cavitation occurred in 55% of males and in 56% of females with increasing frequency from 15 years of age in the former and from age 14 in the latter. Microbiological confirmation of diagnosis was obtained in 254 (78%) cases, 52% in those aged 10-13 years and 86% in those > or = 14 years. Pleural effusion was present in 42 (13%), 26 males and 16 females (p < 0.05). Thirteen (7%) of the 182 hospitalized adolescents and 27 (19%) of the ambulant group did not complete therapy. The nature of tuberculous disease in adolescents changed dramatically with increasing age.

A novel approach to monitoring adherence to preventive therapy for tuberculosis in adolescence.

To evaluate the usefulness of a microelectronic tablet-dispenser for monitoring adherence to preventive therapy for tuberculosis infection in adolescents. Twenty-one patients with positive Mantoux tests were treated with isoniazid (INH), dispensed in a microelectronic tablet-dispenser that recorded the date, time and duration that the container was opened. Other measures of adherence included attendance at clinic, patient self-report, tablet count, and measurement of urinary INH metabolites. The mean adherence rates were: 83% using attendance at clinic, 91% using tablet counts, 79% using urine assays, and 66% using the electronic tablet-dispenser. Self-reporting appeared to over-estimate adherence. Adherence to 6 months of INH calculated using different measures is higher in this study than in previous reports. Microelectronic tablet-dispensers are an effective method to objectively measure adherence on a daily basis. Other measures are less helpful.

Tuberculosis in children and adolescents: California, 1985 to 1995.

To describe the epidemiology and clinical characteristics of tuberculosis (TB) among children and adolescents and to define children at risk for TB. 4607 children 0 to 14 years of age and 1615 adolescents 15 to 19 years of age reported with TB in California. We analyzed surveillance data reported to the California Department of Health Services TB Control Branch from 1985 through 1995. TB cases increased 22% among children 0 to 4 years of age and 66% among children 5 to 14 from 1985 through 1995. Case rates were highest among children 0 to 4 years of age (13/ 100000 children), but declined from 1993 to 1995, except for black children 0 to 4 years of age. Minority children 0 to 14 years of age had case rates 6- to 34-fold higher than did white children. Pulmonary TB was the most common site of disease in all age groups (71 to 82%). TB meningitis was most common in children 0 to 4 years of age (5%). Most children (64%) did not have cultures done; however, among culture-proved cases isoniazid-resistant Mycobacterium tuberculosis was isolated in 7%. Adolescents were more likely to have cavitary pulmonary disease (24%), to be foreign-born (78%) or homeless (4%) and to have an isoniazid-resistant strain isolated (13%) than were children 0 to 14 years of age (P < 0.05). TB in children and adolescents increased substantially in the mid-1980s and early 1990s. Pediatric TB remains a serious health problem, especially among minority children and adolescents. Our findings indicate that TB control programs need improved strategies to prevent infection and detect disease in this population.

Use of the Bacille Calmette-Guerin Vaccination for the Prevention of Tuberculosis: Renewed Interest in an Old Vaccine

AbstractThe reemergence of tuberculosis,including the impact of HIV infection and multidrug- resistant tuberculosis, have renewed interest in the bacille Calmette-Guerin (BCG) vaccine. During the past 7 decades, numerous studies have shown variable efficacy of BCG vaccination, ranging from 0% to 80%. The BCG vaccine is more likely to prevent disseminated forms of tuberculosis in children than pulmonary tuberculosis in adolescents or adults. Bacille Calmette-Guerin vaccination is recommended in asymptomatic children with or at risk for HIV infection, but it rarely may cause disseminated BCG infection and should not be used in persons with symptomatic HIV infection or AIDS. In healthcare workers with exposure to Mycobacterium tuberculosis, including multidrug-resistant tuberculosis, BCG vaccination generally is not recommended. Revaccination with BCG does not confer more benefit than initial vaccination, and repeat vaccinations should be discontinued. With recent advances in technology and a better understanding of the immunopathogenesis of tuberculosis, efforts to develop a more potent and specific vaccine need to be pursued. If a more effective vaccine against tuberculosis is developed, vaccination can be expected to have an additional impact on global tuberculosis control in conjunction with current strategies of case detection, treatment of disease, and preventivetherapy.

Use of the bacille Calmette-Guérin vaccination for the prevention of tuberculosis: renewed interest in an old vaccine.

The reemergence of tuberculosis, including the impact of HIV infection and multidrug-resistant tuberculosis, have renewed interest in the bacille Calmette-Guérin (BCG) vaccine. During the past 7 decades, numerous studies have shown variable efficacy of BCG vaccination, ranging from 0% to 80%. The BCG vaccine is more likely to prevent disseminated forms of tuberculosis in children than pulmonary tuberculosis in adolescents or adults. Bacille Calmette-Guérin vaccination is recommended in asymptomatic children with or at risk for HIV infection, but it rarely may cause disseminated BCG infection and should not be used in persons with symptomatic HIV infection or AIDS. In healthcare workers with exposure to Mycobacterium tuberculosis, including multidrug-resistant tuberculosis, BCG vaccination generally is not recommended. Revaccination with BCG does not confer more benefit than initial vaccination, and repeat vaccinations should be discontinued. With recent advances in technology and a better understanding of the immunopathogenesis of tuberculosis, efforts to develop a more potent and specific vaccine need to be pursued. If a more effective vaccine against tuberculosis is developed, vaccination can be expected to have an additional impact on global tuberculosis control in conjunction with current strategies of case detection, treatment of disease, and preventive therapy.