Pulmonary Tuberculosis In Children Research Articles

Evaluation of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard

Background: Globally Tuberculosis (TB) is a major infectious disease. In 2011, there were an estimated 8.7 million new cases with 6% childhood tuberculosis. The majority of the cases occurring in high TB burden countries worldwide. Confirmed diagnosis of childhood TB remains challenging for physicians. MT test and Chest X-ray usually has very little diagnostic value for the diagnosis of pulmonary tuberculosis in children who has symptom criteria suggestive of PTB. Objectives: This study was done to evaluate of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard. Methods: The cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College & Mitford Hospital from January 2020 to June 2021. A total of 48 subjects of both sexes with the age range from 1 month to 59 months were included in the study. Data were collected over a period of eleven months and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 22. Results: In this study, most of the children 14 (29.2%) lies between 13 months to 24 months. About most of the children 28 (58.33%) were male and 20 (41.67%) children were female. According to the clinical presentation majority of the children present with fever 39(75.0%), followed by cough (72.9%) and weight loss (50%), history of contact was present in 15 (31.3%) children. Chest X-ray of 54% children was suggestive of PTB (as Consolidation, Milliary mottling, patchy opacity etc) 46% showed normal X-ray findings. Gene X-pert of Induced sputum could detect M.Tuberculosis in case of 12.5% children and in 87.5% cases Gene X-pert could not detect M.Tuberculosis in induced sputum. M.Tuberculosis was detected by Stool X-pert in 18% of children who were clinically diagnosed as PTB. In 82% of patient stool X-pert could not detect M.Tuberculosis. Conclusion: Gene Xpert test of stool specimen is a relatively easy test for the diagnosis ........

TB or not TB? Diagnostic Sensitivity, Specifity and Interobserver Agreement in the Radiological Diagnosis of Pulmonary Tuberculosis in Children.

The differentiation between latent tuberculosis infection (LTBI) and tuberculosis (TB) relies on radiological changes. Confirming the diagnosis remains a challenge because typical findings are often missing in children. This study evaluates diagnostic sensitivity, specifity and interobserver agreement on the radiological diagnosis of TB by chest-x-rays in accordance to professional specialization and work experience. Chest x-rays of 120 children with proven tuberculosis infection were independently evaluated by general radiologists, paediatric radiologists and paediatric pulmonologists. Results were compared to a reference diagnosis created by group of experienced paediatric radiologists and paediatric pulmonologists. Primary endpoints were diagnostic sensitivity and specificity and interobserver variability defined as Krippendorfs alpha of thesel groups compared to the reference diagnosis. Of the 120 chest x-rays 33 (27,5%) were diagnosed as TB by the reference standard . Paediatric pulmonologist had the highest diagnostic sensitivity (90%) but were less specific (71%) whereas general radiologist were less sensitive (68%) but more secific (95%). The best diagnostic accuracy was achieved by pediatric radiologists with a diagnostic sensitivity of 77% and specificity 95% respectively. We demonstrated significant interobserver variability and relevant differences in sensitivity and specificity in the radiological diagnosis of TB between the groups. Paediatric radiologists showed the best diagnostic performance. As the diagnosis of pulmonary TB has significant therapeutic consequences for children they should be routinely involved in the diagnostic process.

Effect of Intensive Phase Anti-tubercular Treatment on Hematological Parameters in Pulmonary Tuberculosis in Children

Aim and objectives: To study the effect of intensive phase ATI on various hematological parameters in pulmonary TB in children. Material and methods: Study design: Prospective observational study. Children were chosen at random from children who were identified and diagnosed at the Dr. Ram Manohar Lohia Hospital in New Delhi's Atal Bihari Vajpayee Institute of Medical Sciences using a straightforward sampling technique. Every patient is diagnosed with pulmonary tuberculosis based on RNTCP standards. The research was conducted from November 2019 to March 2021 (one year four months). Results: Hemoglobin count (t-value -2.914), Red Blood Cells (t-value -4.338), Platelet Count (t-value -4.762), Lymphocytes (t-value -4.472), Monocyte (t-value 5.991),ESR count (t-value 5.118), Packed Cell Volume (t-value -4.228), Mean Corpuscular Volume (t-value -3.418), Platelet Large Cell Ratio (t-value -4.254), C-reactive count (t-value 3.131), Ferritin (t-value 4.747), X-ray (t-value 5.213) significant at <0.05 level respectively. Conclusion: The various parameters used in the study as the inflammatory process have an extremely important part in the TB pathogenesis. These parameters can be used as markers can be used for prognosis, response to treatment, and follow-up purposes. It can increase the predicting accuracy of treatment outcomes as ones can monitor the TB cases objectively in addition to subjective parameters (improvement in clinical symptoms and examination findings, weight gain, Increase in appetite). Anti-tuberculosis Drug Treatment (ATT) is highly successful in enhancing hematological parameters, which suggests that responders' immune responses have improved in an indirect manner.

Literature Study: Risk Factors for Tuberculosis in Children

Tuberculosis (TB) is one of the most deadly diseases in the world. Every day nearly 4,400 people lose their lives due to tuberculosis and nearly 300,000 people fall ill due to this disease. The aim of this research is to find out what factors influence the incidence of tuberculosis in children. The method used in this research is literature review. The results show that risk factors that influence the incidence of pulmonary tuberculosis in children include parental knowledge, nutritional status, BCG immunization status, history of contact with sufferers, exposure to cigarette smoke and residential density

Risk factors in the delay of treatment of childhood tuberculosis in a Peruvian Hospital

To determine the risk factors associated with delayed initiation of tuberculosis (TB) treatment in children under 15 years of age. Case-control study. Patients <15 years of age with a diagnosis of childhood pulmonary tuberculosis (c-PTB) with delayed treatment initiation >24 hours were included. Clinical and epidemiological variables were evaluated: age, gender, guardian's education, poverty level, origin, family history of TB, altered imaging findings, symptomatic, PPD >10mm, histology, bacteriology, resistance to treatment, and healthcare network. Bi and multivariate logistic regression analysis was performed, through which odds ratios were calculated. We evaluated 116 patients with c-PTB with a delayed initiation of specific treatment of more than 24 hours, and 264 with start of treatment in the first 24 hours. The delay in anti-tuberculosis treatment had a median of 3 days with an interquartile range of 2 to 7 days. The patient with the least educated guardian had a delay in treatment initiation with an odds ratio of 7.47 (95%CI: 4.13 - 13.52). Belonging to the healthcare network A of Callao decreased the probability of having tuberculosis by 0.224 times (95%CI:0.11 - 0.46). Incomplete education level of the guardian is a risk factor associated with delayed initiation of c-PTB treatment in children under 15 years of age while belonging to the Callao healthcare network A is a factor that decreases the risk in the group under study.

Comparison of chest radiographs against minimum intensity projection reconstruction computed tomography scans for detection of airway stenosis in children with lymphobronchial tuberculosis.

Ideally, suspected airway compression in symptomatic children with lymphobronchial tuberculosis (TB) would be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. However, in TB-endemic regions with limited resources, practitioners rely on conventional radiography for diagnosing TB and its complications. Furthermore, airway compression detected on conventional radiographs would upgrade a patient into the severe category according to the new World Health Organization guidelines, precluding the patient from shorter treatment protocols. The accuracy of conventional radiographs in the context of detecting airway compression in children with TB has not been specifically evaluated against an imaging gold standard. We aimed to compare frontal chest radiographs against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine observer agreement between the modalities regarding the degree of stenosis. This retrospective cross-sectional study compared chest radiographs with standardized angled coronal CT MinIP in children with symptomatic lymphobronchial TB at ten predetermined airway locations. Chest radiographs were evaluated by one pediatric radiologist and CT MinIP reconstructions were independently interpreted by three readers. Sensitivity and specificity were calculated using CT MinIP as the gold standard. Stenosis was graded as 1 for mild (1-50%), 2 for moderate (51-75%), 3a for severe (76-99%), and 3b for total occlusion (100%). Agreement between the two modalities regarding severity of stenosis was calculated using the kappa coefficient for each affected site. A total of 37 patients were included in the study. The median age of patients was 14.3 months (interquartile range 8.0-23.2). Three hundred and seventy individual bronchi (10 from each of the 37 patients) were evaluated for stenosis. Chest radiographs showed that 31 out of 37 (84%) patients had stenosis in at least one of ten evaluated sites, most commonly the left main bronchus and bronchus intermedius, and this was confirmed via CT MinIP. The gold standard (CT MinIP) demonstrated stenosis in at least one of ten sites in all 37 patients (100%). Left main bronchus stenosis was detected by chest radiography with a 92.9% sensitivity and 100% specificity. Sensitivity and specificity for bronchus intermedius stenosis were 80% and 75%, respectively. There was substantial agreement for grade of stenosis between chest radiographs and CT (kappa=0.67) for the left main bronchus and moderate agreement (kappa=0.58) for the bronchus intermedius. Severe stenosis was found in 78 bronchi on CT compared to 32 bronchi (Grade 3a: 9, Grade 3b: 23) on chest radiographs. The diagnosis of pulmonary TB in children continues to rely heavily on imaging, and we have shown that in young children, chest radiographs had a high sensitivity and specificity for detecting airway stenosis at certain anatomical sites, when adequately visualized, resulting from tuberculous lymph node compression at left main bronchus and bronchus intermedius. For most sites, the interobserver agreement was poor. Stenosis of the left main bronchus and bronchus intermedius should be the focus of chest radiograph interpretation and can assist both diagnosis and classification of patients for treatment.

Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis

BackgroundDespite tuberculosis (TB) being a curable disease, current guidelines fail to account for the long-term outcomes of post-tuberculosis lung disease—a cause of global morbidity despite successful completion of effective treatment....

Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates. Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2–113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children ≤ 4 years of age and in those with uncomplicated TB (p=0.008).Conclusions: Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.What is known:• The diagnosis of paediatric tuberculosis is a challenge for paediatricians• Despite their low sensitivity gastric aspirates represent the standard sample for microbiological confirmation of active pulmonary tuberculosis in children• Most international guidelines recommend performing three sequential gastric aspirates on three consecutive daysWhat is new:• A significant increase in global sensitivity by 13.4% was found by the collection of three gastric aspirates compared to the first one• Performing a higher number of gastric aspirates increases the sensitivity of microbiological confirmation, particularly in children ≤ 4 years and with an uncomplicated radiological pattern

Diagnostic Utility of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) on Induced Sputum Versus Gastric Aspirate Samples for the Diagnosis of Paediatric Pulmonary Tuberculosis.

Tuberculosis (TB) in children is neglected, mainly due to a lack of sensitive diagnostic tools. Paediatric TB is now a global priority. More paediatric TB cases are being recorded as a result of the introduction of Xpert® Mycobacterium tuberculosis (MTB)/rifampicin (RIF) (Cepheid Inc., Sunnyvale, USA). This study was undertaken to evaluate the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children. We recruited 70 paediatric patients with probable pulmonary TB and their gastric aspirate (GA), and induced sputum (IS) samples were collected between January 2021 and June 2022 in Saifai, Etawah, Uttar Pradesh, at the Microbiology Department of the Uttar Pradesh University of Medical Sciences (U.P.U.M.S.). All samples were subjected to smear examination, Bacterial Activation ofContinuousTemperature andEnvironmentalControl -MycobacterialGrowthIndicatorTube (BACTEC-MGIT) culture, and Xpert MTB/RIF. The specimens included 70 GAs and 70 IS samples. The total number of specimens were 140 and we collected GA as well as IS from each of the patient enrolled in the study.When compared to microscopy, GeneXpert provides a quicker and earlier detection of paediatric TB. The sensitivity of the cartridge-based nucleic acid amplification test (CBNAAT) against mycobacterial growth indicator tube (MGIT) was 75.0% for GA samples and 63.64% for IS samples. Paediatric TB, owing to its paucibacillary nature and difficulty in the collection of samples, makes the diagnosis difficult by conventional methods. Our study shows that smear and culture yield in GA samples are superior to those of IS samples and the sensitivity of Xpert MTB/RIF assay is also significantly different in GA and IS samples, but a combination of GA and IS yielded the best results.

TB-LAMP (loop-mediated isothermal amplification) for diagnosing pulmonary tuberculosis in children

TB-LAMP (loop-mediated isothermal amplification) for diagnosing pulmonary tuberculosis in children

Quantitation of Circulating Mycobacterium tuberculosis Antigens by Nanopore Biosensing in Children Evaluated for Pulmonary Tuberculosis in South Africa.

Nanopore sensing of proteomic biomarkers lacks accuracy due to the ultralow abundance of targets, a wide variety of interferents in clinical samples, and the mismatch between pore and analyte sizes. By converting antigens to DNA probes via click chemistry and quantifying their characteristic signals, we show a nanopore assay with several amplification mechanisms to achieve an attomolar level limit of detection that enables quantitation of the circulating Mycobacterium tuberculosis (Mtb) antigen ESAT-6/CFP-10 complex in human serum. The assay's nonsputum-based feature and low-volume sample requirements make it particularly well-suited for detecting pediatric tuberculosis (TB) disease, where establishing an accurate diagnosis is greatly complicated by the paucibacillary nature of respiratory secretions, nonspecific symptoms, and challenges with sample collection. In the clinical assessment, the assay was applied to analyze ESAT-6/CFP-10 levels in serum samples collected during baseline investigation for TB in 75 children, aged 0-12 years, enrolled in a diagnostic study conducted in Cape Town, South Africa. This nanopore assay showed superior sensitivity in children with confirmed TB (94.4%) compared to clinical "gold standard" diagnostic technologies (Xpert MTB/RIF 44.4% and Mtb culture 72.2%) and filled the diagnostic gap for children with unconfirmed TB, where these traditional technologies fell short. We envision that, in combination with automated sample processing and portable nanopore devices, this methodology will offer a powerful tool to support the diagnosis of pulmonary TB in children.

Analysis of changes in reporting and diagnosis of pulmonary tuberculosis among children in Liangshan Yi Autonomous Prefecture, Sichuan Province from 2019 to 2021

Objective: To compare the characteristics of children's pulmonary tuberculosis (PTB) cases reported from 2019 to 2021 before and during the implementation of the Action Plan to Stop Tuberculosis. Methods: Based on the reported incidence data and population data of child pulmonary tuberculosis (PTB) notified to the Chinese Center for Disease Control and Prevention (CDC) Tuberculosis Information Management System (TBIMS) from 2019 to 2021, the population information and clinically relevant information in different years were compared. Results: From 2019 to 2021, the reported cases of PTB in children were 363, 664 and 655, respectively. The number of reported cases increased significantly. The median age of the cases in children increased from 10.4 years in 2019 to 11.7 years in 2021 (P=0.005) over a three-year period. The etiological positive rate increased significantly from 11.6% (42/363) in 2019 to 32.2% (211/655) in 2021 (P<0.001). The positive rate of molecular testing increased most significantly, which became the main means of etiological detection and accounted for 16.7% (7/42), 62.0% (57/92) and 75.4% (159/211) of the children with positive etiological results, respectively. The resistance rates of isoniazid and rifampicin were analyzed in children with PTB who underwent drug sensitivity tests. The results showed that the resistance rates of isoniazid and/or rifampicin were 2/9, 3.9% (2/51) and 6.7% (11/163), respectively, with an average of 6.7% (15/223) over three years. The median patients' delay was 27 (12, 49) days in 2019. It was reduced to 19 (10, 37) days in 2020 and 15 (7, 34) days in 2021, both significantly lower than 2019 (P=0.009 and 0.000 2, respectively). Conclusion: From 2019 to 2021, the reported numbers of children with PTB and children with positive etiological results increase significantly in Liangshan Prefecture, while the diagnosis delay of patients significantly reduces.

Genetic diversity and drug sensitivity profile of Mycobacterium tuberculosis among children in Ethiopia.

Worldwide, tuberculosis (TB) affects about one million children every year. The burden of the disease is higher in developing countries. However, there is limited information on the lineages and drug sensitivity patterns of Mycobacterium tuberculosis (M. tuberculosis) infecting children in these countries, including Ethiopia. Thus, this study aimed to characterize the different lineages of the M. tuberculosis complex causing childhood pulmonary tuberculosis and evaluate the drug-sensitivity patterns to the first-line anti-TB drugs. A total of 54 stored cultures were used in this study. The region of difference 9 (RD9) based polymerase chain reaction (PCR) and spoligotyping were employed for the identification of the isolates at the species and lineages level respectively. Lineage identification was done by using the pre-existing database. Identification of clustering of the spoligotype patterns was by using the SPOLIDB3-based model. The result was retrieved by the most probable family format. Furthermore, the phenotypic, and genotypic drug-sensitivity test (DST) was performed using Mycobacterium Growth Indicator Tube (MGIT™ 960) and GenoTypeMTBDRplus assay respectively. Data analysis was done using SPSS version 27 software. Spoligotyping produced 39 interpretable results for M. tuberculosis. The majority (74.4%) of them were clustered into 7 groups, while the rest (25.6%) were single. The Euro-American (EA) lineage was the predominant lineage (64.1%) followed by the East-African Indian (EAI) (30.8%) and M. Africanum (5.1%) lineages. The most predominant subtypes were SIT37 (15.4%), SIT149 (12.8%), SIT25 (7.7%), and SIT53 (7.7%). Furthermore, of the identified SITs, T1 and CAS families consisted of 38.5% and 28.2% of the lineages respectively. Drug susceptibility was 91.9% by phenotypic method and 97.4% by molecular assay. The overall prevalence of any resistance was 7.8% and there was a single MDR-TB. Many of the isolates belong to the modern lineages (Euro American) representing the most common circulating strains in the country. More importantly, despites the tiny isolates tested, drug resistance is low. To fully describe the molecular epidemiology of MTBC lineages in children, we recommend a prospective large-scale study.

Fissural Pleural Effusion Presenting As ‘Pseudotumor Lung, Phantom Tumour or Round Pneumonia’ In Primary Pulmonary Tuberculosis: Bronchoscopy is Point of Care Test in Presence of Satellite Nodules in Chest Imaging!

Pulmonary Tuberculosis has diverse radiological presentations such as consolidation, cavitation, airway disease, pleural effusion and lymphadenopathy. Pneumonia-like presentation in tuberculosis is very commonly reported in Pulmonary Tuberculosis. Fissural effusion is common in cardiac failure and isolated fissural effusion is rarely described in literature with etiology as tuberculosis. Round pneumonia is commonly described in pediatric cases with community acquired pneumonia and also frequently reported in childhood pulmonary tuberculosis. Round pneumonia is very infrequently reported in adults with pneumonia and to very few published data as due to tuberculosis. In this case report, a 21-year female, presented with constitutional symptoms for 3 months duration with partial response to medical treatment received in line with pneumonia, bronchial asthma and bronchitis. Radiological investigations documented round opacity in right mid-zone with no adventitious breath sound on clinical examination. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax and documented loculated right horizontal fissural effusion with subpleural parenchymal opacity in right upper lobe posterior segment and right middle lobe lateral basal segment with peri-consolidation satellite nodules in right posterior segment. We have done bronchoscopy due to negative induced sputum microbiological workup. Bronchoscopy guided BAL microbiological workup documented MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test and negative BAL smear for AFB. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms and typical radiological features such as ‘round pneumonia or fissural effusion’ in absence of other causes for the same. Fissural effusion or round pneumonia due to tuberculosis is rare in adults but not uncommon. Bronchoscopy is a gold standard test to confirm etiological diagnosis due inadequate or poor quality of induced sputum sample in cases with round pneumonia and fissural effusion. Isolated Fissural effusion secondary to pulmonary tuberculosis is extremely rare in medical literature and this will be first case reported till date.

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.

Pulmonary Tuberculosis in Children: A Forgotten Disease?

Even today, tuberculosis in childhood is a disease that is often undiagnosed and undertreated. In the absence of therapy with antituberculosis drugs, children in the first years of life have a high degree of severe forms and mortality. In these children, symptoms are often not very specific and can easily be confused with other diseases of bacterial, viral or fungal etiology, making diagnosis more difficult. Nevertheless, the introduction of new diagnostic techniques has allowed a more rapid identification of the infection. Indeed, Interferon gamma release assay (IGRA) is preferred to the Mantoux, albeit with obvious limitations in children aged <2 years. While the Xpert Mtb/RIF Ultra test is recommended as an initial diagnostic investigation of the gastric aspirate and/or stools in children with signs and symptoms of pulmonary tuberculosis. The drugs used in the treatment of susceptible and resistant TB are the same as those used in adults but doses and combinations are different in the pediatric age. In children, brief therapy is preferable in both the latent infection and the active disease, as a significant reduction in side effects is obtained.

SARS-CoV-2 infection and pulmonary tuberculosis in children and adolescents: a case-control study

BackgroundThe Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic has had an impact on the global tuberculosis (TB) epidemic but evidence on the possible interaction between SARS-CoV-2 and TB, especially in children and adolescents, remains limited. We aimed to evaluate the relationship between previous infection with SARS-CoV-2 and the risk of TB in children and adolescents.MethodsAn unmatched case-control study was conducted using SARS-CoV-2 unvaccinated children and adolescents recruited into two observational TB studies (Teen TB and Umoya), between November 2020 and November 2021, in Cape Town, South Africa. Sixty-four individuals with pulmonary TB (aged < 20 years) and 99 individuals without pulmonary TB (aged < 20 years) were included. Demographics and clinical data were obtained. Serum samples collected at enrolment underwent quantitative SARS-CoV-2 anti-spike immunoglobulin G (IgG) testing using the Abbott SARS-CoV-2 IgG II Quant assay. Odds ratios (ORs) for TB were estimated using unconditional logistic regression.ResultsThere was no statistically significant difference in the odds of having pulmonary TB between those who were SARS-CoV-2 IgG seropositive and those who were seronegative (adjusted OR 0.51; 95% CI: 0.23–1.11; n = 163; p = 0.09). Of those with positive SARS-CoV-2 serology indicating prior infection, baseline IgG titres were higher in individuals with TB compared to those without TB (p = 0.04) and individuals with IgG titres in the highest tertile were more likely to have pulmonary TB compared to those with IgG levels in the lowest tertile (OR: 4.00; 95%CI: 1.13– 14.21; p = 0.03).ConclusionsOur study did not find convincing evidence that SARS-CoV-2 seropositivity was associated with subsequent pulmonary TB disease; however, the association between magnitude of SARS-CoV-2 IgG response and pulmonary TB warrants further investigation. Future prospective studies, evaluating the effects of sex, age and puberty on host immune responses to M. tuberculosis and SARS-CoV-2, will also provide more clarity on the interplay between these two infections.

Features of detection of latent tuberculosis infection and tuberculosis in children from household contacts within a household (clinical case)

Aim: to demonstrate the features of detection and diagnosis of latent tuberculosis infection and pulmonary tuberculosis in children from household contacts based on own clinical observation.&#x0D; Materials and methods. A clinical case of own observation of pulmonary tuberculosis and latent tuberculosis infection in children from household contacts who were treated in the paediatric department of the clinical base of the Phthysiatry and Pulmonology Department of Zaporizhzhia State Medical and Pharmaceutical University on Public Non-Profit Enterprise of the “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology” of Zaporizhzhia Regional Council.&#x0D; Results. Children from household contacts were examined at ages: 8 months, 2, 3, 5 and 7 years, after their mother was diagnosed with tuberculosis (TB). All children showed an increase in tuberculin skin test, at the X-ray of the thoracic cavity organs (TCO) no changes were detected in any child. Taking into account the age of the children and their constant residence with the index patient, a decision was made to conduct an additional examination using CT scan of the TCO. Thus, three children were diagnosed with pulmonary tuberculosis – primary tuberculosis complex, and two were infected. After receiving the results of the culture test in the gastric lavage, the youngest child was found MBT, which was resistant to first-line drugs, namely isoniazid and rifampicin, which required a treatment regimen adjustment. It should be noted that the youngest girl, who was not vaccinated, had the most widespread process in the lungs compared to other children.&#x0D; Conclusions. Monitoring and screening of children who have been in contact with the index patient within the household maximises the detection of additional cases of latent tuberculosis infection and pulmonary TB. The most at-risk groups are those who not vaccinated with BCG vaccine and children under 5 years of age. Early detection and timely prescription of anti-TB therapy is the key not only to effective treatment, but also to preventing the transmission of TB infection.

Agenesis of the Right Pulmonary Artery Associated with Patent Ductus Arteriosus: A Case Report

Introduction: Unilateral pulmonary artery agenesis is a rare congenital malformation that can be the source of serious complications. Its diagnosis must be considered in the presence of recurrent respiratory infections. Adult patients are often asymptomatic, which makes the diagnosis difficult. Chest CT angiography is the reference examination. We report a case of agenesis of the right pulmonary artery associated with patent ductus arteriosus revealed at the age of 50 years on a thoracic CT angiography. Observation: A 50-year-old female patient, treated for pulmonary tuberculosis in childhood, presented with exertional dyspnea. Thoracic CT angiography showed agenesis of the right pulmonary artery with patent ductus arteriosus and right pulmonary hypoplasia. There was significant systemic vascularity with evidence of pulmonary hypertension and right heart failure. Discussion: Unilateral pulmonary artery agenesis has been rarely reported in association with a patent ductus arteriosus. Right pulmonary artery agenesis often presents as an isolated, asymptomatic finding without associated congenital heart defects. CT angiography is used to make the diagnosis. Management is often limited to surveillance. Conclusion: Isolated pulmonary artery agenesis is a rare congenital malformation but its true frequency is not well known because of the inherent difficulties in its diagnosis. The main problem remains the risk of serious complications which requires regular follow-up.

Tuberculosis revisted: classic imaging findings in childhood

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.Graphical