History Of BCG Vaccination Research Articles

Miliary Tuberculosis with Tuberculous Meningoencephalitis in Children Under Two Years of Age with a Missed Opportunity of Immunization: A Case Report

Miliary TB is one of the manifestations of TB with incidence 3-7% among all TB cases and 13% can spread to brain as Tuberculous Meningitis (TBM). This case report discusses a case of miliary TB complicated with meningoencephalitis in children under two years of age without history of BCG vaccination. A 23-month-old girl with severe malnutrition, came to outpatient clinic with fever for 6 months, cough for 3 months, gland enlargement in the neck, no history of BCG and no history of TB contact. Because the chest x-ray showed miliary TB, we decided to hospitalized the patient. Suddenly she had loss of consciousness and seizures in the way to pediatric ward. After being managed and stabilized, we decided do head CT scan with contrast and found multiple rim enhancing lesions, with a smooth inner outer layer. Mycobacterium Tuberculosis was detected without rifampicin resistance by Polymerase Chain Reaction (PCR) TB from sputum speciment, but not detected in liquor cerebro spinal (LCS). Cerebrospinal fluid analysis showed mononuclear cell dominant (87%). The patient was given broad spectrum antibiotic, anti-seizures drug, and intensive phase anti-tuberculosis drugs with RHZE and steroid. The patient was discharged with clinical improvement after 3 weeks of treatment but had sequelae of cerebral palsy. Early detection and appropriate management are crucial in pediatric patients with miliary TB to reduce mortality rate and prevent TBM, which can lead to permanent neurological disabilities.

Does intravesical Bacillus Calmette-Guérin for bladder cancer protect from COVID-19?

The study aimed to correlate the history of intravesical BCG as well as infantile BCG immunization with the incidence and severity of COVID-19 infection. Retrospective data collection of patients with high-risk non muscle invasive bladder cancer (NMIBC) from two Canadian centers. Data collection included a history of BCG instillation, infantile immunization, and the development of COVID-19 infection. Admission and/ or mortality because of COVID-19 was reported. We could include data from 348 patients: including 188 and 160 patients from Ontario and British Columbia respectively. COVID-19 affected 15% of these patients. Intravesical BCG was used in 44% of these patients. Intravesical BCG and/or infantile BCG immunization did not correlate with the incidence of COVID-19 infection. Previous intravesical BCG and/ or a history of infantile BCG vaccination were not more/ less frequent in patients who had COVID-19 infection.

Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India.

Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.

RELATIONSHIP BETWEEN BCG VACCINATION HISTORY AND THE INCIDENCE OF LEPROSY IN CHILDREN: A LITERATURE REVIEW

Background: Globally, 9,052 new cases of leprosy in children were reported, with a corresponding rate of 4.5 per million child population. Children are believed to be the most vulnerable group to M. leprae infections due to their immature immunity. Purpose: This study aims to determine the relationship between the history of BCG vaccination and leprosy incidence in children. Methods: This study used a literature review method that involved a systematic search. The data sources were obtained using several databases, namely Google Scholar, Proquest, Science Direct, and Pubmed. Keywords were built using the PICOS protocol and Boolean Operators, so the keywords used were "relationship" AND "BCG vaccine" AND "leprosy" AND "children". The research selection and search procedures were explained using the PRISMA 2020 method and research included in this study following the inclusion and exclusion criteria that have been set. Results: There were eight studies suitable for inclusion in this literature review. Five articles concluded that there was a relationship between the history of BCG vaccine and the incidence of leprosy in children, while three articles concluded that there was no relationship between the two variables. Conclusion: The BCG vaccine is useful as an effort to prevent the transmission and spread of leprosy in children. Children who do not receive BCG immunization are more susceptible to leprosy than those who receive immunization. The BCG vaccine has a protective effect to prevent children from contracting and transmitting leprosy to other people.

Comparison of antiphenolic glycolipid-1 antibody levels in seropositive contacts of leprosy after 2 years of single-dose rifampicin as postexposure prophylaxis.

Leprosy is still a global problem, especially in developing countries, including Indonesia. Ineffective prevention of leprosy leads to active transmission of the disease. World Health Organization (WHO) recommend post-exposure prophylaxis (PEP) with single dose of rifampicin (SDR) for leprosy patients. Previous study showed protective effect of SDR against leprosy, especially for the first 2 years. Hence, the use of PEP and IgM anti PGL-1 examination are required to suspend the chain of leprosy transmission. This study evaluated the effectiveness of SDR administration by comparing IgM anti-PGL-1 antibody levels in seropositive household contacts before and after 2 years of SDR administration. Analytical observational laboratory study comparing IgM anti PGL-1 antibody levels before and after 2 years of SDR administration in leprosy contacts, with a prospective follow-up study design. We conducted this study from December 2022 to January 2023 at Dr. Mohammad Hoesin General Hospital Palembang. All seropositive household contacts of leprosy who had been administrated SDR 2 years ago were included, then PGL-1 antibody levels were examined. The use of SDR showed significant improvement in leprosy contacts after 2 years (P=0.000). The median antibody level before SDR administration was 1,209.20 (615.81 - 4,353.60), which decrease to 146.03 (0 - 2,487.80) U/mL after 2 years. There was statistically significant relationship between history of BCG vaccination (P=0.003) and IgM PGL-1 antibody levels after 2 years of SDR administration. There is a significant decrease in IgM anti PGL-1 antibody levels among leprosy contacts after 2 years of SDR chemoprophylaxis administration.

Analisis Faktor Risiko TB paru Anak yang Tinggal Serumah dengan Penderita TB paru Dewasa

Pulmonary tuberculosis (TB) is still a major public health problem in Indonesia. Based on the Household Health Survey (SKRT) results tuberculosis is the number one respiratory disease and infectious disease. Tuberculosis in children causes growth disorders and even death. If pulmonary tuberculosis in a child is not treated immediately, it can quickly develop into parenchymal or tubercular pneumonia, milliary tuberculosis, bone tuberculosis (scrofuloderma), joint tuberculosis, abdominal tuberculosis, and even meningitis. This study used a case-control design with analytical observation. Children who were exposed to and lived in the same household with adult pulmonary tuberculosis patients as many as 90 adults participated in the study. The case sample consisted of children aged 0-15 years who were diagnosed with Pulmonary TB by doctors at the Wania Health Center, Mimika Regency. The case sample size was 30 respondents and the control sample was 30 respondents. The free variables in this study were parental knowledge, BCG vaccination history, child nutritional status, occupancy density, the behavior of TB sufferers at home, and length of contact. Data were analyzed using univariate analysis, bivariate analysis, and multivariate analysis (multiple logistic regression). The results of the study analysis showed that the factors that influence the incidence of tuberculosis in children are parental knowledge (p = 0.001), BCG vaccination history (p = 0.001), and the behavior of adult tuberculosis sufferers in the household (p = 0.000) The conclusion of the study was that the behavior of adult pulmonary tuberculosis patients who lived in the same house with children was most influential in the transmission of pulmonary tuberculosis in children who lived in the same household as adult pulmonary tuberculosis patients at the Health Centre of Wania, Mimika District.

History of infantile BCG immunization did not predict lamina propria invasion and/or high-grade in patients with non-muscle invasive bladder cancer

To evaluate the utility of infantile BCG vaccination history in predicting stage and grade of tumours in non-muscle invasive bladder cancer (NMIBC). We retrospectively analyzed data from patients from a single center who were diagnosed with new NMIBC and underwent transurethral resection of bladder tumour (TURBT) between 2017 and 2022. We assessed BCG immunization status with various demographics and comorbidities, as well as tumour recurrence, progression, stage, and grade. A total of 188 patients met the inclusion criteria for our study. The mean age of patients at the time of diagnosis was significantly lower in those that had been immunized with BCG (71 ± 9) than those who had not (77 ± 10) (p < 0.0001). History of BCG immunization did not correlate with sex, history of diabetes mellitus (DM), prior history of intravesical BCG treatment, and tumour recurrence, progression, stage, and grade. History of infantile BCG vaccination did not correlate with the depth of invasion and/or the grade in patients with non-muscle invasive bladder cancer. Patients that received infantile BCG vaccination were significantly younger at the time of diagnosis of NMIBC.

Paediatric progressive primary tuberculosis

A previously healthy 13-year-old Japanese girl with a BCG vaccination history and no tuberculosis (TB) exposure history presented to the hospital with mild dyspnea for 1 month and fever for 5 days. Computed tomography showed consolidation with a pleural effusion, obstructed left main bronchus with an air bronchogram, and traction bronchiectasis of the left upper lobe (Fig. 1A, B). No improvement was observed with ampicillin. Computed tomography on day 23 showed a new granular shadow in the right upper lobe (Fig. 1C). Despite a negative interferon-gamma release assay (IGRA) result, the sputum on day 55 was positive for acid-fast bacilli on a ZiehlNeelsen stain and Mycobacterium tuberculosis on polymerase chain reaction. A fourdrug antituberculous regimen was initiated and she recovered rapidly. TB exposure history, positive tuberculin skin test or IGRA, and typical imaging findings are the triad for primary TB diagnosis (Perez-Velez and Marais, 2012; Lewinsohn et al., 2017; Ahmed et al., 2020). In pediatric primary TB, consolidation may be present and can be misdiagnosed as bacterial pneumonia; however, massive consolidation is rare (GriffithRichards et al., 2007). Primary pulmonary TB should be considered in children with lung consolidation that is unresponsive to antibiotics, despite negative IGRA and TB exposure history.

Risk Factor Identification of Multi-Drug Resistant Tuberculosis

Background: Multi-drug resistant tuberculosis (MDR-TB) is a serious health problem with high morbidity and mortality. The identification of risk factors is needed to prevent the incidence TB-MDR. Objective: To identify the risk factors of TB-MDR in the Special Region of Yogyakarta.Method: This study used a case control design to assess the risk factors for the incidence of MDR-TB. Patients diagnosed with MDR-TB compared to non-MDR TB patients were then compared to exposure to the risk factors studied. The results of the study were analyzed by calculating the mean and proportion. Next, Chi-square tests and analysis of odds ratio (OR) with 95% confidence interval (CI) were conducted using a 2x2 dummy table as an aid with multivariate logistic regression analysis.Result: There were 53 patients with MDR-TB as the case group and 106 non-MDR TB patients as controls. There were no significant differences between the two groups regarding the characteristics of age, sex, place of residence, and type of work (p&gt;0.05). The multivariate analysis found the risk factors associated with an increased incidence of MDR-TB were a history of previous TB treatment (p&lt;0.001; OR 31.82; 95%CI: 9.40-107.77) and surrounding TB (p&lt;0.01; OR 4.45; 95%CI: 1.45-13.70), while other factors that were not significantly related to the incidence of MDR-TB included body mass index, distance of home to health facilities where taking medicine, smoking, drinking alcohol, history of BCG vaccination, education, income, medication adherence, and comorbidities (p&gt; 0.05).Conclusion: The risk factors found to be associated with an increased incidence of MDR-TB in this study were the presence of surrounding TB patients and a history of previous TB treatment.

Detection of Mycobacterium Tuberculosis IgM and IgG Antibodies and Associated Risk Factors Among Apparently Healthy Undergraduate Students of a Private University in South-West Nigeria

Background: Infection with Mycobacterium tuberculosis (TB) is frequent among Nigerians. Many people are infected without realizing it (asymptomatic) and thus provide a risk of transmission to others. Not only will early treatment prevent TB complications, but it will also help to break the infection cycle in a community.&#x0D; Objective: The study was conducted to determine the prevalence of Mycobacterium tuberculosis IgM and IgG antibodies and associated risk factors among apparently healthy undergraduate Students of Babcock University, Ilishan-Remo, Ogun State. &#x0D; Methodology: The serum samples of 100 consenting participants were collected randomly and screened for TB antibodies using Aria TB IgG/IgM Combo Rapid Antibody Test Cassette (CTK Biotech Inc. Poway, CA 92064, USA). A structured questionnaire was administered to consenting students to obtain information on their bio-data (e.g, the age, sex, study level etc.), as well as clinical information regarding their health (History of TB, history of BCG vaccination, use of anti-TB medications, alcohol consumption, smoking habits etc.). &#x0D; Results: The outcome of this study shows that 15 (15%) out of the 100 participants screened, were positive for TB IgG antibody, while, only 1 (1%) person was positive for TB IgM antibody. There was no significant association (P&gt;0.05) between percentage TB IgG positivity and the socio-demographic characteristics of the study participants (gender, age, study level and tribe), except for religion. The percentage of TB IgG positivity among the study participants was found to be significantly higher than of TB IgM positivity (P&lt;0.05). None of the 15 participants who tested positive to TB IgG indicated any of the signs and symptoms (persistent cough, chest pain, nausea, fever, chills, loss of appetite, fatigue and night sweat) associated with TB), however the only person who tested positive for TB IgM indicated all, except night sweat. Identified risk factors associated with the occurrence of TB IgM include history of TB, lack of BCG vaccination, history of diabetes and physical unfitness. &#x0D; Conclusion: The findings of this study show that asymptomatic and latent tuberculosis infection exists among the study participants, and that if left untreated, it will progress to active tuberculosis with all of its associated complications, including death. This emphasizes the importance of ongoing public health education, BCG vaccination, and periodic screening to detect asymptomatic cases in the study population in order to break the infection cycle.

Covid-19 y antecedente de vacunación con bacilo calmette-guerin en habitantes del cantón Jipijapa y su asociación a la morbimortalidad

Coronaviruses have the ability to make humans and animals sick, they cause respiratory infections for the most part. COVID-19 reached an exponential rate of contagion and spread on a large scale. Trained immunity is a type of non-specific immune response, similar to memory induced by some pathogens and vaccines. Previous research has shown that the Bacillus Calmette-Guerin or BCG vaccine can confer protection against a wide variety of pathogens. Those countries where BCG is administered at birth have shown a lower infection rate and fewer deaths related to COVID-19, suggesting that this vaccine may confer some protection against SARS-CoV-2. The objective of this work is to analyze the serological profile of COVID-19 and the history of vaccination with Bacilo Calmette-Guerin in inhabitants of the Jipijapa canton and its association with morbidity and mortality. To obtain results, a methodology with a descriptive, ambispective, cross-sectional design was applied, with an explanatory level. 142 patients with a confirmatory diagnosis of COVID-19 were included, selected without distinction of age, gender or ethnic group, in which the history of BCG vaccination was investigated. The results are indicative that those individuals older than 60 years without a history of BCG vaccination constituted the group with the highest mortality, given the vaccination history in Ecuador and in the canton specifically and the frequency of lethality in the population under study, given that the BCG vaccine is applied to newborns and is not more than 45 years old, being administered in the country. A history of BCG vaccination was important in reducing the risk of TB infection, however, it was also associated with lower mortality from COVID-19. Although there is an epidemiological association between BCG and COVID-19, in the absence of well-designed and controlled clinical studies, the BCG vaccine is not recommended as a preventive measure for COVID-19.

Interferon-gamma release assays for latent tuberculosis infection screening in Canadian federal correctional facilities

BACKGROUND: The correctional setting presents an opportunity for latent TB infection (LTBI) screening in an otherwise difficult to reach demographic. We evaluate factors associated with the fidelity of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), specifically the QuantiFERON®-TB Gold In-Tube assay (QFT-GIT), explain factors associated with discordance, and report LTBI treatment outcomes.METHODS: We describe the association between demographic and clinical variables, and predictors of concordance with IGRA using univariate logistic regression in a population of TST-positive inmates. We report outcomes among those offered LTBI treatment.RESULTS: We observed concordance between TST and QFT-GIT in 90 of 306 (29.4%) inmates. Persons with TST+/QFT-GIT+ results were less likely to be male (OR 3.94, 95% CI 1.73-8.97) or have a BCG vaccination history (OR 0.34, 95% CI 0.12-0.95), and more likely to be foreign-born (P < 0.001). Of the 108 inmates offered LTBI treatment, 65 (60.1%) accepted and 51 (78.0%) completed. TST/QFT-GIT discordance has not been associated with disease during follow-up.CONCLUSION: Our findings suggest that TST/QFT-GIT discordance in Canadian federal inmates is common; however, low-risk of disease progression in those with discordance suggests that a shift towards IGRA-based screening is warranted and feasible.

Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis.

The diagnosis of tuberculosis (TB) in children is difficult because of the low sensitivity and specificity of traditional microbiology techniques in this age group. Whereas in adults the culture of Mycobacterium tuberculosis (M. tuberculosis), the gold standard test, detects 80% of positive cases, it only detects around 30–40% of cases in children. The new methods based on the immune response to M. tuberculosis infection could be affected by many factors. It is necessary to evaluate the medical record, clinical features, presence of drug-resistant M. tuberculosis strains, comorbidities, and BCG vaccination history for the diagnosis in children. There is no ideal biomarker for all TB cases in children. A new strategy based on personalized diagnosis could be used to evaluate specific molecules produced by the host immune response and make therapeutic decisions in each child, thereby changing standard immunological signatures to personalized signatures in TB. In this way, immune diagnosis, prognosis, and the use of potential immunomodulators as adjunct TB treatments will meet personalized treatment.

Preventive Role of BCG Vaccination in CNS Tuberculosis

Introduction: Generally, prospective randomized trials of BCG have been used to evaluate efficacy of BCG, and retrospective case-control studies of BCG have been used to compare effectiveness of different BCG vaccine strains. Objectives of the study: The basic aim of the study is to analyze the preventive role of BCG vaccination in CNS tuberculosis. Material and methods: This study was conducted in the Paediatric Department of Bahawal Victoria Hospital, Bahawalpur during 2019 to 2020. All suspected cases of tubercles meningitis were evaluated by taking detailed history according to the designed proforma especially considering age, sex, socioeconomic conditions of family, history of contact with tuberculosis patients, BCG status and presenting complaints of fever, headache, neck stiffness of more than 2 weeks duration along with history of fits and loss of consciousness. Results: A total 53 patients were included in the study. Thirty seven patients (69.81%) had no BCG scar. Among this group 35(66.03%) patients had not been vaccinated with BCG. Two (3.77%) patient had history of BCG vaccination but no scar (Vaccination failure). Conclusion: Although many studies have shown higher sensitivity of PCR on sputum but the decrease sensitivity in case of CSF. TB prevention effectiveness of BCGs varies by manufacturer. Ascertaining the relative effectiveness of BCG vaccines from different producers may have implications when setting national and global policy, as use of strains that offer superior protection may be more cost-effective

Evaluation of the effect of T regulatory cell depletion and donor BCG vaccination on Mycobacterium tuberculosis H37Ra infection using an in vitro model of human PBMC infection.

This study evaluated the effect of T regulatory cells (Treg cells) and the impact of BCG vaccination history of donors using an in vitro model of Mycobacterium tuberculosis H37Ra infection of peripheral blood mononuclear cells (PBMCs). PBMCs from donors with or without prior BCG vaccination were depleted of Treg cells (PBMCs-Tregs) or not depleted with Treg cells (PBMCs+Tregs) were infected up to 8 days with Mtb H37Ra. Cell aggregates were smaller in PBMCs-Tregs compared to PBMCs+Tregs at day 8 post-infection. Mtb CFUs were higher in the PBMCs-Tregs compared to PBMCs+Tregs at days 3, 5 and 8. The levels of IL-17, IFN-γ (at days 3 and 5), and TNF-α and IL-6 (at day 3) were lower in PBMCs-Tregs compared to PBMCs+Tregs. In contrast, the levels of IL-10 and IL-4 cytokines were higher at day 3 in PBMCs-Tregs compared to PBMCs+Tregs. BCG vaccination status of donors had no impact on the mycobacterial culture, level of cytokines and immune cell populations. This study shows that depletion of Tregs in human PBMCs infected with Mtb H37Ra in vitro leads to a shift from a Th1 to a Th2 cytokine rich environment that supports the survival of Mtb in this model.

Seroprevalence of COVID-19 Amongst Health Care Workers in a Tertiary Care Hospital of a Metropolitan City from India

Background: Seroprevalence studies for COVID-19 evaluate the extent of undetected transmission in a defined community, with special significance among health care workers (HCW) owing to their greater exposure and potential to transmit.Methods: A total of 1122 HCW (approximately 25% of the employees) of a large tertiary care hospital in India were recruited for this cross-sectional study. COVID PCR-positive HCW were excluded. Based on their risk-assessment, participants were grouped into three categories. A questionnaire was administered and they were tested for SARS-CoV-2-IgG antibodies using the chemiluminescence.Findings: The overall seroprevalence among workers was 11.94%, which included 19.85% in COVID units, 11.09% in non-COVID units, and 8% in administrative workers. Antibody prevalence was highest in the department of gastroenterology (11.94%), followed by oncology (10.53%), pathology (10.26%), emergency medicine (7.84%) and critical care medicine (7%). Housekeeping staff, food and beverage staff, lab assistants and technicians had higher seroprevalence rate than doctors and nurses (p Interpretation: BCG vaccination, HCQ prophylaxis, and the job profile influence the seroprevalence rate in HCW. Seroprevalence rate and follow-up evaluation of its durability may help hospitals to triage their staff at risk, rationalize their placement, prioritize the use of PPE, thereby potentially reducing the risk.Financial Support: No external funding was involved in this study.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study was approved by the internal ethical committee of the institute.

DETERMINING THE NEED FOR ADDITIONAL TESTING WITH QUANTIFERON TB GOLD IN PATIENTS WITH POSITIVE TUBERCULIN SKIN TEST AND HISTORY OF BCG VACCINATION

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The tuberculin skin test (TST) has been the traditional method for the diagnosis of latent tuberculosis infection (LTBI) for many years. However recently Quantiferon TB gold (QFT) has become the definitive means of diagnosis of LTBI. However QFT is a more expensive test with needs for special equipment and skilled personnel. The purpose of this study is to determine which patient characteristics in patients with positive TST and previous history of BCG vaccination are associated with positive QFT so that we can eliminate the need for additional QTB testing in this patient population. We hypothesize that in patients with high risk features of TST induration diameter of 20mm and more, recent immigration to the USA, advanced age, country of origin with high endemicity, known exposure to active tuberculosis (TB) and smoking history, a positive TST likely expresses true exposure and less likely represents cross reactivity from positive BCG. METHODS: Retrospective chart review was done on adult patients who were referred to our pulmonary clinic with positive TST from January 2014 until December 2019. Patient data was extracted from medical records. The patients were divided into 2 groups. Group 1 consisted of true positive TST patients who had BCG vaccination and were positive for QFT. Group 2 consisted of false positive TST patients who had BCG vaccination but were negative for QFT. The 2 groups were compared with each other to determine if the high risk features were more prevalent in Group 1 compared to Group 2. RESULTS: In total 76 patients met the criteria for our study. Group 1 had 23 patients and Group 2 had 53 patients. The results showed that Group 1 had a higher prevalence of patients with advanced age (4.2%) compared to Group 2 (3%). Patients with exposure to active TB were more prevalent in Group 1(8.3%) compared to Group 2(5.3). However patients with smoking history were more prevalent in Group 2(11.1%) compared to Group 1(4.2%).The above differences were not statistically significant. Patients with TST induration of 20mm and more were more prevalent in Group 1 (60.9%) compared to Group 1(37.7%).The P value in this category alone was trending towards significance with a value of 0.06. Both Group 1 & 2 had equal distribution of patients with recent immigration (16.7%). Patients from Mexico constituted the single largest number of patients in both Group 1(54.2%) & in Group 2 ( 27.7%). CONCLUSIONS: High risk features of large TST size, recent immigration to USA, advanced age, country of origin with high endemicity, known exposure to active TB patients and smoking history does not indicate that positive TST expresses true exposure. Therefore QFT is still needed for definitive confirmation of LTBI. CLINICAL IMPLICATIONS: QFT is a superior testing study than TST for confirmation of LTBI. Hence patients with positive TST must undergo QFT testing to confirm the diagnosis of LTBI. DISCLOSURES: No relevant relationships by Antony Arumairaj, source=Web Response No relevant relationships by Imnett Habtes, source=Web Response No relevant relationships by Hansang Park, source=Web Response No relevant relationships by Fernando Quesada, source=Web Response

The reliability of tuberculin skin test in the diagnosis of latent tuberculosis infection in psoriasis patients: A case-control study.

Tuberculin skin test (TST), which is used in the diagnosis of latent tuberculosis infection, may cause Koebner's phenomenon and false-positive results in psoriasis patients. The purpose of this study is to compare TST with QuantiFERON-TB Gold Plus (QFT-plus) test in psoriasis patients and to determine the effects of psoriasis on TST results. Ninety-two psoriasis patients and 30 control subjects were included in the study. QFT-plus test, TST, and prick test to distinguish the increase of induration because of the skin trauma were performed on both groups. The demographics, risk factors for latent tuberculosis infection, BCG vaccination history, Koebner's history, psoriasis severity, and treatment history of the patients were recorded. The effects of these variables on test results were investigated by comparing those with control group. The criteria of National Tuberculosis Diagnosis and Treatment Guidelines were used in the evaluation of test results, and threshold value of positivity for TST was taken as 10 mm in BCG-vaccinated patients who are planned to start biological treatment. Prick test results were negative in the control group. There was no significant relation between the results of prick test and TST induration diameters in the patient group. Although TST positivity was significantly higher in patients (62%) compared with control group (33%), QFT-plus test results were not statistically different between two groups. Agreement between two tests was determined to be low in patient group with 48% (K = 0.1), and it was determined to be moderate with 77% in control group (K = 0.4). QFT-plus test was found to be negative in 46 of 57 TST-positive patients (80.7%) in patient group. It was determined in both groups that vaccination did not have any effect on test results. When threshold value was lowered to 5 mm in patient group without considering BCG reaction, the number of TST-positive patients increased from 57 to 65. Mean TST induration diameter was 10 mm and 14 mm in cases with mild and moderate to severe clinical manifestation, respectively (P = .04). However, no effect of disease period and treatment was determined on both test results. TST positivity was higher in psoriasis patients compared with control group. It was considered due to the increased reaction of the skin to mycobacterial antigens rather than the Koebner's response. Although TST results were not affected by BCG, it was concluded that a 10-mm threshold value of positivity was a suitable approach in order to reduce the number of patients receiving unnecessary preventive treatment in patients who are considered to initiate biologic agents. Furthermore, it was also concluded that QFT-plus test may be preferred in psoriasis patients since it is applied in vitro and its specificity is higher and not affected by disease severity.

Study of Clinico-Radiological Profile in Childhood Tuberculosis

Background: Tuberculosis still is one of the deadliest diseases in the world killing nearly 2 million people every year. In India, two deaths occur every three minutes from tuberculosis. The actual global disease burden of childhood tuberculosis is not known, as childhood Tuberculosis is notoriously difficult to diagnose because of the absence of a ‘gold standard’ as bacteriologic confirmation is rarely achieved. The present study was designed to study clinical profile of various forms of childhood TB. Objective of this study was to study clinic-epidemiological profile of various forms of childhood TB.Subject and Method:Retrospective analysis of clinical profile of 100 patients of childhood TB in the age group of 6 months to 12 years. A detailed clinical history, family history of contact with Koch’s disease, history of BCG vaccination of each child was recorded. A complete examination was carried out and findings regarding the general and systemic examination were recorded. Result:Age distribution in our study showed that 51% cases in the age of 5-12 years, 47% cases in the age group 1-5 years and 2 % cases falling in the age group 0-1 years, with male to female ratio of a 1.27:1. 95% of the patients belonged to the lower socio-economic class. The distribution of TB was- pulmonary tuberculosis(42%),TBME(30%),pleural effusion(12%),abdominal TB (12%), TB lymphadenitis(4%), Osteotuberculosis(2%), miliary TB(2%). 12% of the patients had mild to moderate malnutrition (PEM Grade I, II)and 57 % were severely malnourished. 72% of the patients were BCG vaccinated and history of Koch’s contact were present in 21% of all cases. The most frequently seen symptoms were fever (88%), cough (65%), weight loss in 50%, anorexia in 35% of cases and in physical examination cachexia was the most common (50%) followed by hepatomegaly (40%),lymphadenopathy(16%) and Splenomegaly (8%) of cases. Conclusion:childhood TB is commonly seen in children more than 1 year, lower socioeconomic class and in severely malnourished children.

BCG vaccination: Effects on the patterns of pediatric leprosy.

Introduction:Leprosy in pediatric population continues to remain as one of the major public health problems in India. BCG vaccination has been implicated in producing some protection against leprosy.Objectives:The present study intended to find out the patterns of leprosy in the pediatric age group (<12 years) and to determine the proportion of paucibacillary (PB) and multibacillary (MB) leprosy cases among the BCG-vaccinated and nonvaccinated groups.Methodology:It is a cross-sectional study among patients with leprosy up to the age of 12 years attending a tertiary care hospital in Eastern India by comprehensive history taking and through clinical examination. The history of BCG vaccination was enquired and the BCG scar was looked for to determine the BCG-vaccinated and nonvaccinated group. After collecting the data in a predesigned case sheet, the data were analyzed.Result:Of the 137 patients included in this study, 71.53% belonged to the 11–12 years age, 27.74% the 5–10 years age, and 1 patient the <5 year age group. The sex ratio was 1:1.63. PB leprosy was more common than MB leprosy. Smear positivity, deformity, and reaction were not very frequent. Among the vaccinated patients, the ratio of PB and MB leprosy was 5.3:1, while in the nonvaccinated group the ratio was 1.2:1. Data analysis showed that the proportion of MB leprosy was statistically significant in the nonvaccinated group than in the vaccinated group (p = 0.0352).Conclusion:Our study pointed that BCG vaccination might have a role in enhancing the cell-mediated immunity (CMI).