Mycobacterium Tuberculosis In Children Research Articles

Role of line probe assay in detection of Mycobacterium tuberculosis in children with pulmonary tuberculosis

BackgroundIndia is the highest TB burden country in the world with almost 27 lakh cases reported in 2019. Pediatric tuberculosis in India accounts for almost 31% of global TB burden. Despite such high mortality and morbidity in children, diagnosis of pulmonary TB in children still remains very challenging. Material and methodsThis cross-sectional study was conducted in a tertiary care hospital in Delhi, India. Children between 1 and 12 months with clinical suspicion of pulmonary tuberculosis who had not previously taken ATT were included.Early morning gastric aspirate samples were collected after overnight fasting, on two days. Both days sputum sample were subjected to sputum smear microscopy and one of the two samples was subjected to line probe assay (LPA), cartridge based nucleic acid amplification (CBNAAT) and mycobacterium growth in tube (MGIT-960). Results84 children with pulmonary tuberculosis were enrolled. The most common presenting complaint was fever seen in 83 patients (98.8%). Only 17 (20.24%) were sputum smear positive by Ziehl- Neelsen (ZN) staining. LPA was positive in 47 (55.95%) samples and among these positive samples both INH and RIF resistance was detected in 2 (4.26%) samples. CBNAAT was positive in 53 patients (63%). Growth in liquid culture media (MGIT 960) was observed in 44 (52.38%) samples. Among 17 smear positive samples, LPA was detected in 14 (82.35%) samples and among 67 smear negative sample LPA was detected in 33 (49.25%) samples. LPA had 63.46% sensitivity, 100% specificity in detecting mycobacterium tuberculosis. DiscussionWHO's recommendation for using LPAs has been limited to culture isolates or smear-positive sputum specimens. New data has since been generated on the use of LPAs as newer versions of LPA have been developed over past few years.Previous studies conducted using LPA version 1.0 reported much lower detection rate of mycobacterium tuberculosis in smear negative specimens.With the availability of newer versions such as Hain GenoTypeMTBDRplusversion 2 and Nipro NTM + MDRTB detection kit 2, the diagnostic utility of LPA may be enhanced.

Evaluation of Xpert MTB/RIF Assay on Stool Samples for the Diagnosis of Pulmonary Tuberculosis among the Pediatric Population.

Objective Microbiological confirmation of tuberculosis (TB) in pediatric cases is challenging due to its paucibacillary nature and difficulty in specimen collection. This study aimed to validate stool as an alternative sample for the diagnosis of pediatric pulmonary TB via Xpert MTB/RIF (Xpert) assay. Materials and Methods This cross-sectional study included 75 pediatric patients up to 10 years of age with signs and symptoms suggestive of TB. From each recruited patient, pulmonary and stool samples were collected in a sterile container. The collected samples were subjected to Ziehl-Neelsen staining, BACTEC MGIT 960 culture (MGIT), Xpert, and in-house multiplex polymerase chain reaction for TB diagnosis. Results About 13.33% (10/75) of the pulmonary samples and, of them, 50% (5/75) of the stool samples were positive by Xpert assay. The sensitivity and specificity of Xpert assay with stool and pulmonary samples were 50 (95% confidence interval [CI]: 18.71-81.29%) and 100% (95% CI: 94.48-100%), respectively. Conclusion The Xpert assay on stool samples showed limited sensitivity and good specificity in the diagnosis of pulmonary TB. Therefore, it can be proposed as an alternative screening sample to diagnose TB in pediatric cases for which getting a respiratory sample is extremely difficult. However, further studies with greater number of samples and multiple baseline variables are required to support our findings. Strategies to optimize stool Xpert assay should be performed to enhance the sensitivity of this method to detect Mycobacterium tuberculosis in children.

Clinical and Radiologic Factors Associated With Detection of Mycobacterium tuberculosis in Children Under 5 Years old Using Invasive and Noninvasive Sample Collection Techniques-Kenya.

Pediatric tuberculosis (TB) remains a critical public health concern, yet bacteriologic confirmation of TB in children is challenging. Clinical, demographic, and radiological factors associated with a positive Mycobacterium tuberculosis specimen in young children (≤5 years) are poorly understood. We conducted a prospective cohort study of young children with presumptive TB and examined clinical, demographic, and radiologic factors associated with invasive and noninvasive specimen collection techniques (gastric aspirate, induced sputum, nasopharyngeal aspirate, stool, and string test); up to 2 samples were taken per child, per technique. We estimated associations between these factors and a positive specimen for each technique using generalized estimating equations (GEEs) and logistic regression. A median (range) of 544 (507-566) samples were obtained for each specimen collection technique from 300 enrolled children; bacteriologic yield was low across all collection techniques (range, 1%-7% from Xpert MTB/RIF or culture), except for lymph node fine needle aspiration (29%) taken for children with cervical lymphadenopathy. Factors associated with positive M. tuberculosis samples across all techniques included prolonged lethargy (median [range] adjusted odds ratio [aOR], 8.1 [3.9-10.1]), history of exposure with a TB case (median [range] aOR, 6.1 [2.9-9.0]), immunologic evidence of M. tuberculosis infection (median [range] aOR, 4.6 [3.7-9.2]), large airway compression (median [range] aOR, 6.7 [4.7-9.5]), and hilar/mediastinal density (median [range] aOR, 2.9 [1.7-3.2]). Identifying factors that lead to a positive M. tuberculosis specimen in very young children can inform clinical management and increase the efficiency of diagnostic testing in children being assessed for TB.

Bedaquiline practice in treatment of extensively drug-resistant mycobacterium tuberculosis in children: Clinical cases

Background. Bedaquiline is currently a drug of choice in therapy for extensively and multidrug-resistant tuberculosis. It is indicated for children from a 6-year age and young adults as part of a combination chemotherapy, in compliance with the medical council’s (MC) regulation on active extensively and multidrug-resistant tuberculosis.Clinical Cases Description. The article describes the clinical cases of bedaquiline treatment of extensively drug-resistant tuberculosis in сhildren. Patient B., 16 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the preliminary diagnosis: exudative pleurisy-complicated S1,2 infiltrative focal tuberculosis of left lung. Mycobactérium tuberculósis (MBT) (-). Complaints of cough, painful chest at deep breath, 37.3°C-elevated body temperature. Chest X-ray: left focal shadows in S1,2, intensive homogeneous darkening due to pleural effusion from diaphragm to anterior segment of rib III. An urgent pleural puncture was performed to sample fluid for MBTculture and PCR resistance tests to streptomycin and rifampicin. The patient was treated with anti-tuberculosis drugs according to the IV chemotherapy regimen. Taking into account the MBTculture results, the Medical Board took the decision to start using the V chemotherapy regimen with the inclusion of up to 180 doses of bedaquiline. The patient received anti-TB drugs according to chemotherapy regimen IV. Based on the pleural fluid PCR tests, the MC prescribed a conversion to chemotherapy regimen V with adding bedaquiline up to 180 doses. After 7 months of positive dynamics, the patient was transferred to continuation phase at a children’s sanatorium. Patient S., 10 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the diagnosis: two-sided bronchopulmonary intrathoracic lymph nodes tuberculosis (ILNTB), calcification phase, MBT (-), follow-up care level I. Given the child’s triple contact with tuberculosis carriers, including extensively drug-resistant (XDR) tuberculosis, the MC prescribed antibacterial drug chemotherapy IF regimen V with adding bedaquiline up to 180 doses: pyrazinamide (Z), prothionamide (Pto), para-aminosalicylic acid (PAS), cycloserine (Cs), bedaquiline (Bq) concurrently with vitamins and hepatoprotectors (ZPtoPASCsBq). After 4 months of positive dynamics, the patient was transferred to anti-bacterial therapy continuation phase 4 (ZPtoCsPAS) for up to 12 months at a children’s sanatorium.Conclusion. The clinical cases presented demonstrate the efficacy of bedaquiline in adolescents having extensively drug-resistant focal pulmonary tuberculosis and intrathoracic lymph nodes tuberculosis. The prescription of bedaquiline in this age cohort requires careful justification and a monitoring of adverse reactions and antituberculosis chemotherapy complications.

Tubercular Bronchoesophageal Fistula in an Adolescent Girl.

Bronchoesophageal fistula is a rare complication of Mycobacterium tuberculosis in children. An adolescent girl who was diagnosed of tubercular mediastinal lymphadenopathy with associated bronchoesophageal fistula at presentation, is reported here. This 16-y-old girl presented with high-grade fever, cough, decreased appetite, weight loss for 3 mo, and breathlessness for 10 d. Chest radiograph revealed hilar lymphadenopathy with bilateral pleural effusion. GA GeneXpert was positive for mycobacterium and rifampicin sensitivity. Despite antitubercular therapy cough persisted and there was a history of dry cough with food intake, especially more on liquids. Bronchoscopy and CECT chest confirmed bronchoesophageal fistula in the right main bronchus just below the carina. Child continued on tube feeding and antitubercular therapy. After completion of intensive phase, child improved with resolution of clinical symptoms and scarring of tract on repeat bronchoscopy. It is concluded that in children with combination of mediastinal lymphadenopathy and persistent cough following intake of food needs careful evaluation for trachea/bronchoesophageal fistula.

Evaluation of TB-LAMP assay for detection of Mycobacterium tuberculosis in children

Background Paediatric tuberculosis remains a major public health problem in developing countries. The diagnosis of tuberculosis in children is challenging because of the paucibacillary nature of the disease, due to which more sensitive nucleic acid amplification tests are needed. In this study, we determined the accuracy of WHO endorsed TB-LAMP assay for detection of Mycobacterium tuberculosis in children. Methods This was a prospective study conducted between March to July, 2018. A total of 177 samples from consecutive suspected TB children were received for microbiological diagnosis of TB. All tests for Mycobacterium tuberculosis detection were performed in parallel (smear microscopy, mycobacterial culture, Xpert MTB/RIF and TB-LAMP). The diagnostic accuracy of index test i.e. TB LAMP were determined using mycobacterial culture as a reference standard. Results Of the 177 samples, 2 (1.1%) were excluded from the study. Among 175 samples, TB-LAMP and Xpert MTB/RIF were positive in 27 (15.4%) and 25 (14.3%) samples, respectively. The sensitivity of both Xpert MTB/RIF and TB-LAMP was same, i.e. 84% (95%CI: 63.9–95.5%), when culture was considered as the reference standard. The specificity, positive predictive value and negative predictive value of TB-LAMP assay was 96% (95%CI: 91.5–98.5%), 77.8% (95%CI: 61.1–88.6%) and 97.3% (95%CI: 93.6–98.9%), respectively. Conclusion For the detection of M. tuberculosis in paediatric samples, TB-LAMP showed a sensitivity and specificity comparable to Xpert MTB/RIF.

Effect of Neutralization of Gastric Aspirate on culture yield of mycobacterium tuberculosis in children with pulmonary tuberculosis

IntroductionConventionally gastric aspirates are neutralized with sodium bicarbonate to improve the culture yield of MTB. However, only limited data is there to support this practice. The aim of this study was to compare the contamination rate, culture yield and time to detection of Mycobacterium tuberculosis (MTB) in neutralized and non-neutralized gastric aspirate samples and report the drug resistance. Materials and methodsA total of 336 neutralized and non-neutralized gastric aspirate samples were simultaneously cultured by both LJ culture and MGIT 960 to compare the difference in isolation rate, time to detection and contamination rate. First line drug susceptibility testing was performed using MGIT 960 SIRE kit. ResultsMTB was isolated from 8.6% (29/336) of GA samples by one or more of the culture methods. The isolation rate of MTB from neutralized and non-neutralized GA samples by combined LJ and MGIT 960 culture was 7.1% (24/336) and 6.8% (23/336), respectively. Both of them detected 18 MTB isolates in common. However, the neutralized and non-neutralized GA samples detected additional 6 and 5 MTB isolates, respectively. The mean time to detection of MTB were similar. In MGIT 960 culture, contamination rate of non-neutralized samples (17%) was significantly lower when compared to neutralized samples (21.1%) (P = 0.044). Drug susceptibility testing of MTB isolates revealed that, out of 26 isolates, 2 were resistant to ethambutol, one each was resistant to isoniazid and rifampicin. ConclusionThe findings of this study suggest that non-neutralized samples should be routinely processed in addition to the neutralized samples for optimum isolation of MTB from gastric aspirate samples.

Bronchial obstructive syndrome in primary infection with Mycobacterium tuberculosis in children

Рurpose. The aim is to study the influence of primary Mycobacterium tuberculosis infection on the occurrence of bronchial obstruction syndrome in children. Materials and methods. A retrospective study of primary medical records of 60 children aged 2 to 6 years for the period from 2016 to 2018, with diagnoses of acute obstructive bronchitis and acute respiratory infection. The patients were divided into 2 groups: group I — 30 children with bronchial obstruction syndrome, II group — 30 people — children with common cold without bronchial obstruction syndrome (control group). We studied the dynamics of reactions to the Mantoux test with 2 TE, contacts with tuberculosis patients, the effectiveness of Vaccinum tuberculosis (BCG-M) vaccination, allergological history, the nature of feeding and allergizing factors in everyday life. Data processing was performed using the NanoStat 1.6 program. Тhe сritical level of statistical significance was assumed to be p < 0.05. Results. It was found that primary Mycobacterium tuberculosis (MBT) infection in children under 4 years has a direct correlation with a high risk of bronchial obstruction syndrome. At the same time, bronchial obstruction syndrome occurred in the absence of local tuberculosis, which can be considered as a paraspecific reaction in the case of primary MBT infection. Сonclusions. The observed relationship between the two phenomena determines the need to examine young children with bronchial obstruction syndrome for MBT infection.

Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens.

INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

Tuberculosis in population of Russian Federation

The epidemic situation with tuberculosis in the Russian Federation is improving, but remains tense. From 2008 to 2018, the tuberculosis incidence rate of the population of the Russian Federation decreased by 1.9 times. The factors affecting the course of the epidemic process of tuberculosis infection are considered: the reliability of indicators, the standard of living of the population, the timely identification of patients with tuberculosis, HIV infection in patients with tuberculosis and the resistance of mycobacterium tuberculosis (MBT) to medicinal anti-TB drugs. The incidence of tuberculosis in some cases underestimated due to deliberate misregistration and registration of newly diagnosed patients with tuberculosis. The use of Diaskintest during mass examinations of children and adolescents does not allow for the timely diagnosis of active tuberculosis in 60 % of children and in 12 % of adolescents identified from the Mantoux test. Primary infection of MBT in children 0–17 years of age with the use of Diaskintest, compared with the use of the Mantoux test (virage), is detected on average only in 6.9 % (from 3.1 to 26.3 %) of children with primary infection (virage) diagnosed by Mantoux test.

Mycobacterium tuberculosis Infection and the development of laryngeal stenosis in children — is there a relationship?

The aim is to study the relationship of Mycobacterium tuberculosis infection and the development of laryngeal stenosis (croup) in children. 250 children with croup aged from 6 months to 8 years were examined.It was found that infection with Mycobacterium tuberculosis in children with laryngeal stenosis (croup) developed at the age of under 4 years. The first episode of croup coincided in 90% of cases with the early period of primary infection with Mycobacterium tuberculosis. A high proportion of close contact with adult tuberculosis patients reached 35% in patients with recurrent laryngeal stenosis (croup). The incidence of tuberculosis among children with repeated episodes of croup was 30%. Anti-TB therapy for latent tuberculosis infection or local forms of tuberculosis led to the cessation of repeated episodes of croup in 85% of cases. Infection with Mycobacterium tuberculosis and active tuberculosis infection is considered as one of the factors contributing to the recurrent course of laryngeal stenosis in children.

Tuberculosis infection in children with negative reactions to the diaskintest

Variants of the course of tuberculosis infection in 54 children from two to 14 years old, negatively reacting to a sample with an allergen tuberculosis recombinant (Diaskintest) were analyzed. There were 3 groups: 1st – 27 children infected with Mycobacterium tuberculosis (MBT), 50. 0% of cases; 2nd – 16 children with newly diagnosed residual post-tuberculosis changes (OPTI), 29. 6% of cases; 3rd group – 11 patients with active tuberculosis, 20. 4% of cases.&#x0D; Methods of examination: intradermal Mantoux test with 2TE and Diaskintest, according to the testimony of a number of patients in vitro tests: QuantiFERON test (QFT), – SPOT test.TV, multispiral computed tomography, bacteriological, molecular genetic methods of investigation on MBT. The method of mass tuberculin diagnostics revealed 70. 4 ± 8. 8% of children of the 1st group, 93. 8 ± 4. 7% of the 2nd group and 54. 6 ± 15. 0% of children of the 3rd group. The duration of infection with MBT in children was different and was less than 1 year in children of the 1st and 2nd groups – 51. 9 ± 9. 6% and 43. 8 ± 12. 4% of cases, respectively, which was significantly more frequent than in patients of the 3rd group (18. 2 ± 11. 6% of cases). Tuberculosis disease occurred in the form of complicated forms of the primary period-in 45. 5 ± 15. 0 % of cases, uncomplicated forms – in 27. 3 ± 3. 4% of cases, generalized lesions – in 27. 3 ± 13. 4% of cases. Diagnosis of a specific lesion occurred equally in the manifest phases of inflammation: infiltration, infiltration and decay (45. 5 ± 15. 0% of cases), and in the phase of ongoing reverse development (incomplete calcination – in 45. 5 ± 15. 0% of cases), one child had a combination of infiltration and calcination phases (9. 1 ± 8. 7% of cases). Residual posttuberculosis changes in children of group 2 were more often formed in the form of calcifications in the organs of the thoracic cavity – in 87. 5% of cases, in 12. 5 ± 8. 3% of patients OPTI was formed by the formation of seals.&#x0D; Conclusion: in children with negative reactions to the Diaskintest requires individual comprehensive diagnosis of tuberculosis infection.

Study on cartridge based nucleic acid amplification test in children with Neurotuberculosis at RNT Medical College, Udaipur, Rajasthan, India

Background: The aim was to determine utility of Cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of mycobacterium tuberculosis in children with neurotuberculosis diagnosed on the basis of clinical evaluation, CSF findings and neuroimaging.Methods: A prospective randomized controlled trial was conducted in Pediatric Department of RNT Medical College, Udaipur, Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, CSF examination and neuroimaging were included in the study.Results: A total 110 children were enrolled. Maximum number of cases admitted with TBME were among 1-5 years of age group (60.91%). CSF and gastric aspirate were examined by CBNAAT for MTB. 5 (4.55%) children had CBNAAT positivity in CSF. Gastric aspirate was positive among 16 (14.55%) children. None of the patient had CBNAAT positive result both in CSF and gastric aspirate.Conclusions: TBME is a major health problem in children below 5 years. Gene Xpert assay has the potential to significantly improve and escalate the diagnosis of smear-negative body fluid specimens. CBNAAT for mycobacterium tuberculosis was positive in 5 (4.55%) children from CSF and 16 (14.55%) from gastric aspirate. Negative CBNAAT should not prevent any patient with suspected features of TBME from starting anti tubercular treatment (ATT) as sensitivity of this test remains low. Final judgement to start ATT should be based on clinical, biochemical and radiological profile especially in CNS tuberculosis.

Croup syndrome and primary infection with mycobacterium tuberculosis in children

Acute respiratory viral infections (ARVI) occupy an important place in infectious pathology of children’s age. One of the frequent and severe manifestations of ARVI, accompanied by respiratory disorders, is stenosing laryngotracheitis (croup syndrome). Primary stenosing laryngotracheitis develops, as a rule, in children of the second-third year of life, rarely-older than 5 years. In 30–50% of patients, croup syndrome recur, often accompanied by signs of bronchial obstruction. The reasons for the formation of the relapses studied enough: discusses the role of concomitant allergic diseases, immune dysfunction, autonomic reactivity, etc. At the same time, the importance of such background conditions as the infection with Mycobacterium tuberculosis, the presence of local forms of tuberculosis (TB) in children in the development of croup syndrome and its recurrence in the literature is not reflected. In the course of our study, it was found that children with primary and recurrent croup are often infected with Mycobacterium tuberculosis at the age of 5 years, which allows them to be classified as at risk of tuberculosis infection; recurrent croup is significantly more often implemented in the early period of primary infection with Mycobacterium tuberculosis and the development of local forms of TB. Chemoprophylaxis and TB therapy can reduce the risk of developing recurrent croup syndrome in 82% of patients. Thus, one of the possible factors in the etiopathogenesis of the syndrome of croup can be a TB infection.

Crystal ball: the yesterday and tomorrow of tuberculosis.

Environmental Microbiology ReportsVolume 11, Issue 1 p. 41-44 Crystal Ball Crystal ball: the yesterday and tomorrow of tuberculosis Pranay Sinha, Corresponding Author Pranay Sinha pranay.sinha@bmc.org 516-633-9920 | Fax: 617-414-5209 Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USAE-mail pranay.sinha@bmc.org; Tel. 516-633-9920; Fax 617-414-5209.Search for more papers by this authorNatasha S. Hochberg, Natasha S. Hochberg Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USASearch for more papers by this author Pranay Sinha, Corresponding Author Pranay Sinha pranay.sinha@bmc.org 516-633-9920 | Fax: 617-414-5209 Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USAE-mail pranay.sinha@bmc.org; Tel. 516-633-9920; Fax 617-414-5209.Search for more papers by this authorNatasha S. Hochberg, Natasha S. Hochberg Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USASearch for more papers by this author First published: 25 December 2018 https://doi.org/10.1111/1758-2229.12726Citations: 1Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume11, Issue1February 2019Pages 41-44 RelatedInformation RecommendedDiagnostic accuracy of Xpert MTB/RIF ultra for detection of Mycobacterium tuberculosis in children: a prospective cohort studyR. Yadav, P. Vaidya, J.L Mathew, S. Singh, R. Khaneja, P. Agarwal, M. Singh, S. Sethi, Letters in Applied MicrobiologyNon-Tuberculosis mycobacterium speciation using HPLC under Revised National TB Control Programme (RNTCP) in IndiaG. Sebastian, S.B. Nagaraja, T. Vishwanatha, M. Voderhobli, N. Vijayalakshmi, P. Kumar, Journal of Applied MicrobiologyAssessment of messenger RNA (mRNA) of Mycobacterium tuberculosis as a marker of cure in patients with pulmonary tuberculosisR.A. Montenegro, K.M. Guarines, L.M.L. Montenegro, L.A.S. Lira, J. Falcão, F.L. Melo, F.C.F. Santos, A.L.A. Nascimento, M.S. Zuzarte, R.C. Leite, H.C. Schindler, Journal of Applied MicrobiologyTowards culturing the microbe of your choiceJ. Cameron Thrash, Environmental Microbiology ReportsRecent updates on drug resistance in Mycobacterium tuberculosisR. Singh, S.P. Dwivedi, U.S. Gaharwar, R. Meena, P. Rajamani, T. Prasad, Journal of Applied Microbiology

The value of nasopharyngeal aspirate, gastric aspirate and bronchoalveolar lavage fluid in the diagnosis of childhood tuberculosis.

Çakır E, Özdemir A, Daşkaya H, Umutoğlu T, Yüksel M. The value of nasopharyngeal aspirate, gastric aspirate and bronchoalveolar lavage fluid in the diagnosis of childhood tuberculosis. Turk J Pediatr 2018; 60: 10-13. Pulmonary tuberculosis (TB) is an important cause of morbidity and mortality especially in developing countries. A definitive microbiologic confirmation of Mycobacterium tuberculosis is important in the diagnosis of childhood TB. We aimed to compare the diagnostic value of nasopharyngeal aspirate (NPA), gastric aspirate (GA) and bronchoalveolar lavage (BAL) specimens in children with highly suspected pulmonary tuberculosis (TB). NPA, GA and BAL samples were obtained from forty patients. The mean age was 9.2±4.7 years. Sixty-eight percent of children had a history of household contact and 82% had tuberculin skin test positivity. Acid-fast bacilli (AFB) stain was positive in 22.5% (N=9) of BAL, 17.5% (N=7) of GA, and 10% (N=4) of NPA samples. Positive Lowenstein-Jensen culture was 27.5% (N=11) in BAL, 22.5% (N=9) in GA, and 12.5% (N=5) in NPA samples. Positive AFB stains and growth in TB cultures from BAL fluid and GA samples were both higher than NPA samples (p < 0.006 and p < 0.004, respectively GA). We conclude that NPA specimen fails to determine Mycobacterium tuberculosis in children with highly suspected pulmonary TB when compared to GA or BAL fluid.

Improved Detection of Mycobacterium tuberculosis in Sudanese Children by use of Insertion Sequence IS6110

This study was carried out in Khartoum state during the period from January 2010 to December 2013 to detect Mycobacterium tuberculosis in children with symptoms of tuberculosis infection using different conventional and advanced diagnostic techniques. One hundred ninety seven specimens of gastric lavage and sputum were collected from different hospital in Khartoum state.specimens were decontaminated and inoculated on Lowenstein Jensen media according to modified Pettrof’s method, two smears were prepared and stained by Ziehl Neelsen stainbacterial DNA was extracted from each specimen by using phenol chloroform method, and then the Polymerase Chain Reaction technique was adopted to detect Insertion Sequence IS6110 gene of M. tuberculosisin in these specimens. This study showed that the positive results for ZN, Culture and PCR were 16 (8.1%), 32 (16.2%) and 35(17.8%) respectively. The study concluded that the PCR technique is a most sensitive and specific technique for a fast identification of M. tuberculosis in gastric lavage and sputum from children who are unable to expectorate good quality sputum sample or diagnosed as negative using conventional diagnostic methods.

Bronchoscopic assessment of airway involvement in children presenting with clinically significant airway obstruction due to tuberculosis

The incidence of complicated lymph node disease in tuberculosis (TB) in children less than 15 years of age varies from 8% to 38%. There are few published studies on the bronchoscopic appearance and severity of airway obstruction caused by lymph node involvement of the airways resulting from Mycobacterium tuberculosis (MTB). The primary aim of the study was to describe the flexible bronchoscopic findings of lymph node involvement of the airways caused by MTB in children with severe airway obstruction. The secondary aim was to compare the degree of airway involvement in HIV negative to HIV positive children as well the airway involvement caused by drug susceptible and drug resistant MTB. All children between 1 month and 13 years of age presenting with clinical and radiological signs of significant airway obstruction suspected of being the result of MTB infection were studied. In addition to routine examination for MTB disease a flexible bronchoscope and bronchoalveolar lavage (BAL) for MTB culture were performed on all the children. Two hundred fifty children (16% HIV positive) were studied. Median age was 14 months and the median weight 8.5 kg. MTB was cultured from 78% (n = 194) of children with the BAL positive in 44%. The BAL culture yield was significantly higher in children with radiological evidence of pneumonia when compared to children with airway involvement alone (P = 0.004). The bronchial tree was obstructed on the right in 85% (n = 212), the left in 66% (n = 164), and both sides in 53% (n = 132) of cases. The commonest sites of obstruction were bronchus intermedius (72%) and left main bronchus (62%). Drug resistance was present in 16% (n = 28). There was no difference in the site or severity of obstruction when comparing drug susceptible to drug resistant cases or HIV positive to HIV negative children. Bronchus intermedius and left main bronchus were the commonest sites of airway obstruction. The MTB culture yield from BAL was higher in children with pneumonia when compared to those with airway involvement alone. HIV positive or children with drug resistant TB did not have more severe airway obstruction.

High prevalence of childhood multi-drug resistant tuberculosis in Johannesburg, South Africa: a cross sectional study

BackgroundThere are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7%, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with Mycobacterium tuberculosis (MTB) at two hospitals in Johannesburg, South Africa.MethodsCulture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of Mycobacterium tuberculosis complex (MTB) was performed using the automated liquid broth MGIT™ 960 method. Drug susceptibility testing (DST) was performed using the MGIT™ 960 method for both first and second-line anti-TB drugs.Results1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n = 21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n = 13) (95%CI, 4.8-14.6%). The prevalence of HIV co-infection was 52.1% in children with drug susceptible-TB and 53.9% in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.ConclusionsThere is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.

Role of Streptococcus pneumoniae in Hospitalization for Acute Community-acquired Pneumonia Associated With Culture-confirmed Mycobacterium tuberculosis in Children

African children hospitalized with symptoms of severe acute pneumonia, which resolves following empiric antibiotic therapy, are sometimes identified to have underlying culture-confirmed pulmonary tuberculosis (PTB). Experimental studies suggest Mycobacterium tuberculosis infection predisposes to Streptococcus pneumoniae infection; however, diagnostic limitations make it difficult to quantify this association in children. We aimed to probe the extent of pneumococcal coinfection in children with PTB, using a vaccine-probe design study. A post hoc analysis of PTB cases occurring among 39,836 participants in a phase III randomized, double-blind placebo-controlled 9-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV9) trial in South Africa was undertaken. Hospitalization for PTB occurring during the 5.3 years of follow-up were identified and categorized as culture-confirmed PTB or probable/possible-PTB. The incidence rates of hospitalized PTB were compared between PCV9 vaccinees and placebo recipients. Hospitalization for culture-confirmed PTB was 43.4% (95% CI, 9.7%–65.1%) less likely among vaccinees (n = 30) compared with placebo recipients (n = 53), incidence, 20 versus 35 per 100,000 child-years of follow-up (P = 0.0117). In HIV-infected children, culture-confirmed PTB was 47.3% (95% CI, 8.6%–69.6%) less likely among vaccinees (n = 19) compared with placebo recipients (n = 36), P = 0.0203. The incidence of possible/probable PTB did not differ by vaccination status. This vaccine-probe design study suggests that in a setting with high HIV and TB prevalence, culture-confirmed PTB in African children, which frequently presents with symptoms of acute pneumonia, is probably associated with superimposed pneumococcal pneumonia. Children admitted with pneumonia in these settings should be investigated for underlying PTB.