Tuberculosis In Adolescents Research Articles

Prioritising children and adolescents in the tuberculosis response of the WHO European Region.

In 2017, in recognition of the challenges faced by Member States in managing childhood and adolescent tuberculosis (TB) at a country level, the WHO Regional Office for Europe held a Regional Consultation. In total, 35 countries participated in the consultations representing both high- and low-incidence Member States. Here, we provide an overview of the existing World Health Organization (WHO) documents and guidelines on childhood and adolescent TB and describe the outcomes of this regional meeting. National childhood and adolescent TB guidelines are available in 25% of Member States, while 33% reported that no such guidelines are at hand. In the majority of countries (83%), childhood and adolescent TB is part of the National Strategic Plan. The most pressing challenges in managing paediatric TB comprise the lack of adequate drug formulations, the difficult diagnosis, and treatment of presumed latent TB infection. Investments into childhood and adolescent TB need to be further advocated to achieve the End TB goals set by WHO to eliminate TB by 2030.

Reasons for late diagnostics of tuberculosis in adolescents

In total the authors reviewed 83 patient records: disease development anamnesis, results of the standard clinical, radiological and laboratory examinations. Tuberculosis in adolescents found during routine examination is characterized by a high epidemic risk (45% of patients were sputum positive), severe clinical forms of the disease with the pronounced residual abnormalities and therefore need of surgical treatments. Patients with the clinical signs of pulmonary disease (pneumonia, bronchitis, recurrent acute respiratory infections) belong to the risk group requiring evaluation for tuberculosis including with the use of immunological skin tests.

BCG Vaccination Induces M. avium and M. abscessus Cross-Protective Immunity.

Pulmonary non-tuberculous mycobacterial (NTM) infections particularly caused by Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MAB) are becoming major health problems in the U.S. New therapies or vaccines which will help prevent the disease, shorten treatment duration and/or increase treatment success rates are urgently needed. This study was conducted with the objective of testing the hypothesis that Bacillus Calmette Guerin (BCG), a vaccine used for prevention of serious forms of tuberculosis (TB) in children and adolescents in tuberculosis hyperendemic countries, induces cross-protective T cell immunity against Mycobacterium avium (MAV) and MAB. Human TB and NTM cross-protective T cells were quantified using flow cytometric assays. The ability of BCG expanded T cells to inhibit the intracellular growth of MAV and MAB was assessed in co-cultures with infected autologous macrophages. In both BCG-vaccinated and M. tuberculosis (Mtb)-infected mice, NTM cross-reactive immunity was measured using IFN-γ ELISPOT assays. Our results demonstrate the following key findings: (i) peripheral blood mononuclear cells from TB skin test-positive individuals contain MAV and MAB cross-reactive T cells, (ii) both BCG vaccination and Mtb infection of mice induce MAV and MAB cross-reactive splenic cells, (iii) BCG-expanded T cells inhibit intracellular MAV and MAB, (iv) CD4, CD8, and γδ T cells play important roles in inhibition of intracellular MAV and MAB and (v) BCG vaccination of healthy volunteers induces TB and NTM cross-reactive T cells. In conclusion, BCG-vaccination induces NTM cross-reactive immunity, and has the potential for use as a vaccine or immunotherapy to prevent and/or treat pulmonary NTM disease.

Changes in Tuberculosis Disease Burden Among South African Adolescents (2005-2015)

Background: South African adolescents have a high force of Mycobacterium tuberculosis (MTB) infection, exceeding 10% per annum, which acts as a barometer of tuberculosis (TB) transmission. We described temporal changes in adolescent TB notification rates to evaluate impact of TB and HIV control measures and inform public health strategy. Method: We conducted a cross-sectional analysis of patient-level TB case data obtained from a regional health authority in Western Cape Province, South Africa, for the decade 2005–2015. Numerators were annual TB notifications (HIV-related and HIV-unrelated); denominators were mid-year population estimates from the national census, adjusted for population growth. Period averages of TB rates were obtained using Auto-Regressive Integrated Moving Average (ARIMA) time series modeling. The Agresti Coull method was used to derive confidence intervals for TB rates. Temporal trends in TB rates were explored using the Mann-Kendall test. Findings: The average adolescent TB notification rate was 477 (95% Confidence Interval (CI): 313–641) per 100,000 for all cases (all-TB) and 361 (CI: 280–441) per 100,000 for microbiologically confirmed cases. However, the adolescent all-TB rate fell by 45% from 662 to 361 per 100,000 (p=0·005) and the microbiologically-confirmed TB rate by 38% from 492 to 305 per 100,000 (p=0·008) between 2005-2015, driven mainly by rapid decreases for the period 2005–2009 (p=0·028 and p=0·027, respectively). Between 2005–2009, 21% (156/732) of adolescent TB notifications were HIV tested, 12% (19/156) of whom were HIV-positive. In the general population, the proportion of HIV-positive persons receiving antiretroviral therapy (ART) increased from <1% in 2005 to 55% in 2015. Interpretation: The encouraging fall in adolescent TB rates between 2005–2009 is not explained by timing of ART roll-out. The subsequent plateau in adolescent TB, coupled with increased rates in younger children, suggests that additional interventions are needed to sustain advances in TB control. Funding Statement: This analysis received no specific funding. Declaration of Interests: All other authors have no other potential conflicts of interest to declare. Ethics Approval Statement: Ethical approval was obtained from the University of Cape Town Human Research Ethics Committee (HREC REF 163/2016).

Химиотерапия и хирургическое лечение поздно выявленного распространенного деструктивного туберкулеза легких у подростков

Химиотерапия и хирургическое лечение поздно выявленного распространенного деструктивного туберкулеза легких у подростков

Research Areas and Trends in Articles on Pediatric and Adolescent Tuberculosis in Korea

목적: 국가 결핵 관리 프로그램을 통해 국내 결핵 발병률과 사망률은 감소하고 있지만, 결핵은 여전히 중요한 감염병이다. 저자들은 국내 소아청소년을 대상으로 한 결핵 관련 논문의 동향과 연구 분야를 분석하여 향후 연구가 필요한 분야를 확인하기 위해 연구를 시행하였다. 방법: 국내외 6개의 데이터베이스에서 ‘tuberculo*’ 또는 ‘TB’, ‘child*’ 또는 ‘adolescen*’ 또는 ‘neonat*’ 또는 ‘infant*’ 또는 ‘pediatric*’ 그리고 ‘korea*’를 포함하여 제목과 초록을 검색하였다. 국내 소아와 청소년을 대상으로 한 결핵 관련 문헌의 논문 종류, 발행 연도, 연구 영역, 투고된 학술지명, 연구 대상을 분석했다. 결과: 검색된 257편의 문헌 중 120편의 논문이 분석에 포함되었다. 이 중 82편(68.3%)은 원저였고, 증례 33편(27.5%), 종설 4편(3.3%), 지침 1편(0.8%)이었다. 원저의 연구 영역을 분류했을 때, 가장 흔한 주제는 임상적 특징(36.6%)이었고 진단(29.3%), 접촉자 조사(9.8%), 역학(6.1%), 치료(4.9%), 백신(3.6%), 잠복결핵감염(3.6%), 합병증(3.6%) 그리고 결핵에 대한 인식(2.4%)에 대한 연구가 뒤를 이었다. 1962년에 출판된 논문을 시작으로 1960년대 4편, 1970년대 10편, 1980년대 11편, 1990년대 22편, 2000년대 26편, 2010년 이후 47편의 문헌이 발표되었다. 결론: 국내 소아를 대상으로 한 결핵 관련 연구는 지난 50년 간 증가해 왔지만, 연구 영역이 임상적 기술과 진단에 치우쳐 있었다. 치료나 백신과 같은 또 다른 영역에 대한 연구가 다양하게 수행되어야 할 필요가 있겠다.

ОПЫТ ПРИМЕНЕНИЯ ДВУХ КУРСОВ БЕДАКВИЛИНА У ПОДРОСТКА С ФИБРОЗНО-КАВЕРНОЗНЫМ ТУБЕРКУЛЕЗОМ И ШИРОКОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ МИКОБАКТЕРИЙ ТУБЕРКУЛЕЗА

The article describes a clinical case demonstrating the possibility of effective and safe administration of two courses of bedaquiline within chemotherapy regimens for multiple/extensive drug resistant respiratory tuberculosis in children and adolescents. In our opinion, the treatment of patients of this age should be carried out in federal centers employing highly qualified specialists in pediatric tuberculosis.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЖНОЙ ПРОБЫ С АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ ДЛЯ ВЫЯВЛЕНИЯ ТУБЕРКУЛЕЗА В СТАВРОПОЛЬСКОМ КРАЕ

The objective of the study: to evaluate the effectiveness of the introduction of screening for tuberculosis using the skin test with tuberculous recombinant allergen (TRA) in children and adolescents in Stavropol Region. Subjects and methods. The method of continuous sampling was used for retrospective analysis of files of 1,112 patients with respiratory tuberculosis in Stavropol Region. There were two time periods distinguished: 2009-2011 and 2016-2018. In 2009-2011, Mantoux test with 2 TU PPD-L was used for screening for tuberculosis in children and adolescents, and in those 15 years old and older, fluorography could be used. Among those of 18-24 years old, fluorography was the only method used. In 2016-2018, a skin test with TRA was used for screening for tuberculosis in children of 8-17 years old. Results. In the clinical structure of tuberculosis in children of 0-14 years old in both periods, the primary forms prevailed. During Period II, the primary tuberculosis complex was detected statistically significantly more often compared to Period I: 31/113 (27.4%) and 11/113 (9.7%) ( p &lt; 0.01; χ2), which was associated with the additional examination of individuals selected based on results of the test with TRA, using spiral computed tomography of the chest, which provided good visualization of this form of tuberculosis. When tuberculosis was detected in adolescents (15-17 years old), the test with TRA demonstrated statistically significant higher efficacy – 46.9% (15/32 of all detected) compared to Mantoux test with 2 TU – 1.5% (1 / 65 of all detected), p &lt; 0.01; χ2. In Period II, the structure of clinical forms of tuberculosis among adolescents improved due to increased incidence of focal tuberculosis from 16.7% (Period I) to 32.5% ( p &lt; 0.05) and decrease in the frequency of lung destruction from 33/84 (39.2%) (Period I) to 3/40 (7.5%), p &lt; 0.05; χ2. Bacillary excretion was registered in 21/84 (25.0%) of the adolescents (Period I) and in 3/40 (7.5%) of them (Period II), p &lt; 0.05; χ2. Dispensary follow-up over preventive treatment in children with a positive and hyperergic reaction to the test with TRA provided a positive effect on the frequency of respiratory tuberculosis development in young people (18-24 years). In the period from 2009 to 2018, the incidence (per 100,000 population) decreased by 69.8%.

High Prevalence of Active and Latent Tuberculosis in Children and Adolescents in Tibetan Schools in India: The Zero TB Kids Initiative in Tibetan Refugee Children.

BackgroundTuberculosis (TB) prevalence is high among Tibetan refugees in India, with almost half of cases occurring in congregate facilities, including schools. A comprehensive program of TB case finding and treatment of TB infection (TBI) was undertaken in schools for Tibetan refugee children.MethodsSchoolchildren and staff in Tibetan schools in Himachal Pradesh, India, were screened for TB with an algorithm using symptoms, chest radiography, molecular diagnostics, and tuberculin skin testing. Individuals with active TB were treated and those with TBI were offered isoniazid-rifampicin preventive therapy for 3 months.ResultsFrom April 2017 to March 2018, we screened 5391 schoolchildren (median age, 13 years) and 786 staff in 11 Tibetan schools. Forty-six TB cases, including 1 with multidrug resistance, were found in schoolchildren, for a prevalence of 853 per 100 000. Extensively drug-resistant TB was diagnosed in 1 staff member. The majority of cases (66%) were subclinical. TBI was detected in 930 of 5234 (18%) schoolchildren and 334 of 634 (53%) staff who completed testing. Children in boarding schools had a higher prevalence of TBI than children in day schools (915/5020 [18%] vs 15/371 [4%]; P < .01). Preventive therapy was provided to 799 of 888 (90%) schoolchildren and 101 of 332 (30%) staff with TBI; 857 (95%) people successfully completed therapy.ConclusionsTB prevalence is extremely high among Tibetan schoolchildren. Effective active case finding and a high uptake and completion of preventive therapy for children were achieved. With leadership and community mobilization, TB control is implementable on a population level.

Progress in research of bacillus calmette-guerin vaccination and repeated vaccination

Tuberculosis (TB) is a serious infectious diseases threating human health, bacillus balmette-guerin vaccine (BCG) is the only available TB vaccine now, neonatal vaccination can significantly reduce the incidence and death of tuberculosis. However, due to its limited protection period, one dose vaccination after birth does not have a protective effect for adolescents and adults. Therefore, how to reduce the prevalence of TB in adolescents and adults effectively is essential for TB prevention and control. In this paper, we reviewed the literature from PubMed, CNKI, and Wanfang database to analyze and summarize the characteristics of BCG vaccine, immune effects and immunity endurance, the effects of BCG vaccination and repeated BCG vaccination in adolescents adults and discuse the change of attitude and trends of BCG use in the three documents issued by the World Health Organization on position of BCG.

Adolescent tuberculosis associated with tuberculosis exposure in classrooms and dorm rooms in Guangxi, China

ObjectiveQuantify tuberculosis (TB) risk attributable to dorm room exposure in addition to classroom exposure. MethodsAdolescent school contact investigations were conducted for every reported index TB case, and similar contact investigations were conducted in selected community-control classes from November 2016 to October 2017 in Guangxi, China. ResultsA total of 6263 contacts of 112 index TB cases and 6130 classmates of 112 controls were investigated. There were 14, 12, and 2 new active TB cases detected among classmates/non-roommates of index cases, classmates/roommates of index cases, and control classmates, respectively. Compared with control contacts, the adjusted relative risk (95% confidence interval (CI)) and population attributable fraction (PAF) for being a classmate/non-roommate of the index case increased the risk of active TB diagnosis to 8.44 (95% CI: 1.31–54.48) and 44.1%. The adjusted RR and PAF for being a classmate/roommate of the index case was 29.37 (95% CI: 3.80, 227.11) and 41.4%. Being classmates/roommates significantly increased the risk of TB compared to a classmate/non-roommate of the index case (RR=3.48, 95% CI: 1.64, 7.40). ConclusionThe additional risk of TB due to exposure in the dorm room should be taken into account in planning of TB prevention and control in boarding schools.

Latent tuberculosis infection and tuberculosis in children and adolescents.

ABSTRACTObjective:To describe the characteristics of patients diagnosed with tuberculosis and latent tuberculosis infection.Methods:A retrospective study, between 2012 and 2015, with data from patients of Programa Einstein na Comunidade de Paraisópolis. To evaluate possible factors associated with patient's sex and diagnoses of tuberculosis and latent tuberculosis infection, χ2 or Fisher's exact tests were used for qualitative variables, and Mann-Whitney test for quantitative or ordinal qualitative variables.Results:A total of 77 patients were evaluated. Age ranged from 6 months to 13.4 years, with a majority of males (54.5%), aged zero to 4 years (54.5%), diagnosed with latent tuberculosis infection (64.9%), and classified as eutrophic (71.2%). The tuberculin test was positive in 92% and in most cases the values were above 10mm (68.0%). Approximately three-quarters of chest X-ray tests were normal (72.7%). After chest X-ray, computed tomography of thorax was the most ordered exam (29.9%), followed by smear and culture for Mycobacterium tuberculosis in the gastric aspirate (28.6%). The frequencies of altered chest X-ray (70.4% versus 4.0%), computed tomography of thorax requests (55.6% versus 16.0%) and other tests requested (81.5% versus 38.0%) were significantly higher in patients with a diagnosis of tuberculosis, relative to those with latent tuberculosis infection, respectively.Conclusion:In our sample, proportions of altered chest X-ray, and performing computed tomography of thorax and other tests in patients diagnosed with tuberculosis were higher than in those with latent tuberculosis infection.

Characterization of tuberculosis in children and adolescents in underdeveloped country

Characterization of tuberculosis in children and adolescents in underdeveloped country

ACTUAL ISSUES OF TUBERCULOSIS IN ADOLESCENTS EXPOSED TO TUBERCULOSIS INFECTION

The article characterizes respiratory tuberculosis in adolescents exposed to tuberculous infection. Exposure to tuberculosis in the family or when contacting close relatives makes the biggest contribution into development of the disease unless the patient is isolated from those exposed. Advanced and severe forms of tuberculosis with bacillary excretion are detected, compromising the life quality of adolescents. The main causes of late diagnostics are poor performance of TB services, primary medical units, low level of health education aimed at the increase of motivation to have planned medical examinations in the general population and to take relevant sanitary and hygienic measures in the sites of infection. Adolescents from the sites with bacillary excretion, and, first of all, if multiple or extensive drug resistant tuberculosis is detected, are to be considered a high priority group facing the risk to develop the disease with more frequent monitoring and deeper examination. In primary medical units, should any sings typical of tuberculosis be presented, it is sensible to add skin tests (Mantoux test and test with tuberculous recombinant allergen) to the minimum diagnostic procedures. Organizational, methodical and health education activities in the sites of infection are to be improved.

Prevalence of tuberculosis infection and disease in children referred for tuberculosis medical surveillance in Ontario: a single-cohort study.

There are few data about the utility of the Canadian tuberculosis medical surveillance system for detecting tuberculosis in children and adolescents. We sought to assess the prevalence of tuberculosis infection and disease in children and adolescents referred by the tuberculosis medical surveillance program who were evaluated at The Hospital for Sick Children (SickKids) tuberculosis program. We retrospectively studied clinical records, radiographic findings and results of interferon-γ release assays (IGRAs) of all children less than 18 years of age referred by the tuberculosis medical surveillance program and evaluated at SickKids between November 2012 and June 2016. The median age of the 216 children was 10.0 years. Most were born in the Philippines (157 [72.7%]) or India (39 [18.0%]). Of the 216, 166 (76.8%) had a history of prior treatment for tuberculosis, and 34 (15.7%) were federal-sponsored refugees from settings with a high tuberculosis burden. Negative IGRA results were found in 110/130 (84.6%) of those with prior tuberculosis treatment. Thirty-one children (14.4%) had any chest radiographic abnormality, of whom 4 had changes thought to be due to tuberculosis. No child received a diagnosis of active tuberculosis at assessment or during follow-up; 3 (1.4%) were treated for latent tuberculosis infection following IGRA testing at SickKids. A positive IGRA result was associated with contact with infectious tuberculosis (odds ratio [OR] 5.97, 95% confidence interval [CI] 2.06-17.52) and older age at first clinic visit (OR 2.98, 95% CI 1.24-8.30) but not with radiographic abnormalities or history of prior tuberculosis treatment. Most children were referred because of a history of prior treatment for tuberculosis; few had clinical or laboratory evidence of infection or prior disease. The tuberculosis medical surveillance process did not identify any children who required treatment for active disease and requires improvement.

Drug-Resistant Tuberculosis in Children and Adolescents in the Republic of Sakha (Yakutia)

Drug-Resistant Tuberculosis in Children and Adolescents in the Republic of Sakha (Yakutia)

АНАЛИЗ ПРИМЕНЕНИЯ КОЖНОЙ ПРОБЫ С ПРЕПАРАТОМ АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ КАК СКРИНИНГОВОГО МЕТОДА ОБСЛЕДОВАНИЯ НА ТУБЕРКУЛЕЗНУЮ ИНФЕКЦИЮ У ДЕТЕЙ СТАРШЕ 7 ЛЕТ В ПЕНЗЕНСКОЙ ОБЛАСТИ В 2014-2016 гг.

The article presents the analysis of efficiency of skin test with tuberculous recombinant allergen (TRA, diaskintest), as a screening method for tuberculous infection in children and adolescents above 8 years old using Penza Region as an example. In 2016, 112,808 persons were screened with TRA test, 97.5% of children were covered with this test. TRA test proved to be effective for detection of tuberculosis in children and adolescents. When TRA test is used, less than 1% respond positively to it among those screened on a regular basis (in 2015 – 0.97% and in 2016 – 0.86%). The differential approach to the prescription of preventive treatment in risk groups significantly increases the motivation of 92.0% of parents to have it. With a positive result of TRA test, the screening for tuberculosis with this test and multispiral computer tomography of the chest significantly improve the structure of clinical forms of tuberculosis in children and adolescents due to an increase of the number of limited lesions with minimal manifestations.

ПЕРСОНИФИЦИРОВАННОЕ ЛЕЧЕНИЕ ТУБЕРКУЛЕЗА ЛЕГКИХ С МЛУ/ШЛУ МБТ У ПОДРОСТКОВ

The article presents 3 clinical cases of treatment of drug resistant tuberculosis in children and adolescents, illustrating the variants of the individual approach to treatment of tuberculosis with multiple/extensive drug resistance In order to improve treatment outcomes, bronchologic methods were used for the collection of specimens for bacteriological tests, chemotherapy regimens were adjusted in a timely manner, valve bronchial block (implantation of endobronchial valve) was used in one the patients to promote the cavity healing, the other patient underwent VATS resection of the upper lobe of the left lung due to numerous large foci As a result, it was possible to use a short course treatment in those patients

Туберкулез у подростков: медико-социальный портрет с учетом эпидемического фактора риска развития заболевания

Туберкулез у подростков: медико-социальный портрет с учетом эпидемического фактора риска развития заболевания

Epidemiological aspects, clinical manifestations, and prevention of pediatric tuberculosis from the perspective of the End TB Strategy.

ABSTRACTTuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatric patients regarding tuberculosis development (rapid progression from infection to active disease), prevention (low effectiveness of vaccination against the pulmonary forms and limited availability of preventive treatment of latent tuberculosis infection), diagnosis (a low rate of bacteriologically confirmed diagnosis), and treatment (poor availability of child-friendly anti-tuberculosis drugs). In this review, we discuss the epidemiology, clinical manifestations, and prevention of tuberculosis in childhood and adolescence, highlighting the peculiarities of active and latent tuberculosis in those age groups, in order to prompt reflection on new approaches to the management of pediatric tuberculosis within the framework of the End TB Strategy.