Tuberculosis In Children Research Articles

Approaches and processes for paediatric chest X-ray classification used in the SHINE TB treatment-shortening trial.

<sec><title>INTRODUCTION</title>SHINE (Shorter Treatment for Minimal Tuberculosis in Children) was the first Phase 3 paediatric TB treatment-shortening trial. Robust chest X-ray (CXR) classification methods were integral to excluding severe disease for trial eligibility and to retrospectively adjudicating TB status at baseline. We describe and critically evaluate the CXR classification approaches and processes used in the SHINE trial.</sec><sec><title>METHODS</title>Children with non-severe TB were randomised to 4- vs 6-months anti-TB treatment. Radiologically non-severe TB was defined on CXR. CXRs were systematically interpreted by on-site clinicians prospectively for eligibility determination and retrospectively by experts to inform adjudication of baseline TB status and disease severity.</sec><sec><title>RESULTS</title>A screening CXR was successfully obtained from all 1,204 enrolled children; 1,134 CXRs from children with intra-thoracic TB were reviewed by expert readers. Compared with the expert panel, enrolling clinicians classified more CXRs as abnormal and 'typical TB' and all as radiologically non-severe. The expert panel retrospectively classified 71/1,134 (6%) CXRs as severe. Of these, 4 (5.6%) had unfavourable outcomes compared with 34 (3.0%) in the trial overall.</sec><sec><title>DISCUSSION</title>Using CXRs to classify radiological disease severity and inform eligibility decisions in real-time by local enrolling clinicians was feasible and safe in this large paediatric TB trial. Retrospective central expert CXR review was successful. Refinement of the CXR methods for the classification of both disease severity and TB status could support standardised implementation in routine care and research.</sec>.

The impact of screening for tuberculosis exposure in the household in children with tuberculosis disease: A difficult riddle to solve.

Tuberculosis (TB) infection is transmitted by sharing the same airway with people with active TB. Children are often not considered the source of TB bacilli, and index case investigation is carried out after diagnosis. Here, we describe the impact of the presence of a household index case on childhood TB disease. The data of patients aged between 1 month and 18 years who were diagnosed with TB were collected. We compared patients according to whether they had an index case in the household or not. A total of 202 TB patients were enrolled, of whom 62 (30.7%) had a household index case. There was no significant difference in having a household index case between TB patients under the age of five (23.3%) and older children (33.8%) (p = .140). Pulmonary TB was present in 61.4% of the cases, and extrapulmonary TB was present in 38.6% of the cases. The rate of patients who had a household index case was significantly higher in pulmonary TB (46.8%) compared to extrapulmonary TB (5.1%) (p < .001). Pulmonary TB patients with a history of household contact were more likely to have diagnostic radiological findings (93.1%) compared to those without (75.8%) (p = .009). However, pulmonary TB patients without household contact history had a higher rate of diagnostic microbiological findings (59.1%) and constitutional symptoms (63.6%) (p = .019 and p = .013, respectively). Household contact research is an important epidemiological tool. However, considering the contact rates in the household, new and more comprehensive public health programs are required to prevent the spread of childhood tuberculosis.

Clinical spectrum of pediatric tuberculosis and early diagnosis by clinical, radiological, and CBNAAT in a Tertiary Care Teaching Hospital in South India

Background: In India, an estimated 220,000 children contract tuberculosis (TB) annually, yet the absence of a gold standard test hinders effective diagnosis and reporting of childhood TB. Objective: This study aimed to analyse the clinical profile of childhood tuberculosis, utilizing relevant laboratory investigations for early diagnosis. Methods: A cross-sectional observational study was conducted at a tertiary care hospital in South India from October 2019 to October 2021. Children under 18 with tuberculosis were included. Data on demographics, symptoms, family TB history, nutritional status, and clinical findings were collected. Laboratory tests included complete blood count, ESR, Mantoux test, chest X-rays, and sputum analyses for acid-fast bacilli (AFB). Results: Among 54 children, the most common age group was over 10 years (51.3%), with a male preponderance (53.3%). Pulmonary TB was diagnosed in 44.4% of cases, while 55.5% had extrapulmonary TB, predominantly pleural (40%). Fever (60.5%) and cough (42.7%) were the most common symptoms. The Mantoux test was reactive in 40.7% of patients, particularly among the undernourished. Chest X-rays indicated TB in 93.25% of pulmonary cases, while CBNAAT showed positive results in 10 cases, with a sensitivity of 18.8% and specificity of 81.25%. Conclusions: Diagnosing childhood TB remains complex, relying on symptom evaluation, clinical history, and laboratory tests. Despite advances in diagnostic methods, negative CBNAAT results do not exclude TB, highlighting the need for thorough clinical assessment and investigation.

Reevaluating Pediatric Osteomyelitis with Osteoarticular Tuberculosis: Addressing Diagnostic Delays and Improving Treatment Outcomes

Background: Pediatric osteoarticular tuberculosis (TB) remains a significant global health challenge, particularly in resource-limited settings, where delayed diagnosis and treatment frequently lead to severe long-term complications. Despite advancements in TB control, skeletal TB in children is often misdiagnosed due to its non-specific clinical presentation, contributing to poor outcomes such as joint deformities, growth disturbances, and chronic pain. The complexity of diagnosing osteoarticular TB is further exacerbated by the limited sensitivity of conventional diagnostic tools and the overlap with other musculoskeletal conditions. This study seeks to evaluate the impact of early detection and multidisciplinary management on treatment outcomes in pediatric patients with osteoarticular TB. Methods: A retrospective review was conducted at the Pediatric Orthopedics Department of the “Grigore Alexandrescu” Children’s Hospital in Romania from 2009 to 2023. Case data included clinical, imaging, and microbiological findings, and treatment outcomes in children aged 0–18 years diagnosed with tuberculous osteomyelitis. Results: The study identified varied clinical presentations, with delayed diagnosis often linked to misinterpretation of symptoms as non-TB infections. Multimodal diagnostic approaches combining imaging, microbiological testing, and histopathology improved diagnostic accuracy. Early surgical intervention alongside anti-TB therapy proved effective in reducing long-term complications. Conclusions: Timely, accurate diagnosis and multidisciplinary treatment are critical to improving outcomes in pediatric osteoarticular TB. Vaccination status and comprehensive diagnostic tools significantly influence disease progression and treatment success. The study underscores the need for enhanced screening and diagnostic methods to prevent delays in treatment.

Tackling the Problem of Childhood Tuberculosis in Bangladesh

Abstract not available BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 1-4

Analysis Neutrophil-to-Lymphocyte and Monocyte-to- Lymphocyte Ratios in Pediatric Respiratory Infections

Indonesia ranks third among countries with the highest tuberculosis (TB) cases worldwide. Pneumonia also stands as a leading cause of death among infants in developing nations. The delay in diagnosing and the challenges in distinguishing TB and pneumonia have significant impacts on elevated morbidity and mortality rates. Both Neutrophil-to-Lymphocyte Ratio (NLR) and Monocyte-to-Lymphocyte Ratio (MLR) serve as inflammatory biomarkers utilized for rapid and straightforward bacteremia evaluation. This study aimed to analyze the difference between NLR and MLR in diagnosing of TB and pneumonia in children. This study was retrospective cross-sectional research utilizing secondary data at the time of initial diagnosis by a clinician as TB or pneumonia. Subjects with TB and/or pneumonia were treated at Dr. Wahidin Sudirohusodo Hospital, Makassar from January 2017 to December 2021. The research sample consisted of 150 patients with pediatric patients with pneumonia. Statistical analyses involved the Kolmogorov-Smirnov test, Mann-Whitney U test, and Receiver Operating Characteristic (ROC). This study examined NLR and MLR as supportive biomarkers for diagnosing TB and pneumonia. The NLR (AUC 0.674) and MLR (AUC 0.63) values in TB subjects were reasonably good in distinguishing between TB diagnosis and healthy subjects. The NLR (AUC 0.77) and MLR (AUC 0.787) values were effective in distinguishing pneumonia diagnosis from healthy control with better sensitivity and specificity compared to TB subjects. However, NLR (AUC 0.401) and MLR (AUC 0.384) values were not recommended to distinguish pneumonia from tuberculosis due to low AUC and extremely low sensitivity and specificity. The NLR and MLR values cannot be used to differentiate TB and pneumonia in children due to their low sensitivity and specificity.

Generalized tuberculosis with intestinal lesion in an adolescent. Case report

In the two recent decades a decrease in tuberculosis (TB) incidence has been observed worldwide, according to the World Health Organization, while the incidence of extrapulmonary TB, including TB of the intestine, is growing. Generally, diagnosis of TB in children and adolescents is difficult due to its subclinical course in a significant part of patients. A special diagnostic challenge is extrapulmonary TB, including abdominal TB. Abdominal TB has entered the top five most frequent manifestations of extrapulmonary TB along with TB of the peripheral lymph nodes, urogenital TB, bone and joint TB, and TB of the central nervous system. Lack of specific clinical signs of the disease results in late diagnosis of abdominal TB. We described a case of generalized TB with intestinal lesion in an adolescent. We detected mistakes in the follow-up of the female patient with double exposure to household TB, which resulted in late diagnosis of the disease. We demonstrated the challenges in diagnosing intestinal TB under the guise of appendicitis, which led to the development of complications – spilled peritonitis and abdominal abscess. The tactics of management of the female patient at high risk for developing bowel obstruction was represented. Interdisciplinary interactions with extrapulmonary TB specialists were accented for cases of generalized TB.

Childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals of Lusaka Zambia from 2015 to 2019.

Treatment outcomes of tuberculosis in children are rarely evaluated. Childhood tuberculosis has been a low priority for tuberculosis programs due to difficulties in diagnosis and treatment. This study evaluated childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals in Lusaka, Zambia from 2015 to 2019. This was a cross-sectional study conducted in eight public hospitals in Lusaka. All children aged 0-14 years, treated with tuberculosis and had treatment outcomes evaluated were included. The WHO tuberculosis treatment outcomes were grouped into successful treatment outcome (cured, treatment completed) and unsuccessful treatment outcome (death, loss to follow-up, failure). Taking unsuccessful treatment outcome as the outcome variable, logistic regression models were performed. All analyses were done at a 95% confidence interval. Out of 2,531 children managed for TB from 2015 to 2019, only 1,495 (59.1%) had treatment outcomes evaluated. Out of 1,495 participants, majority were 5 to 14 years old (50.9%), males (51.1%), HIV-negative (58.7%), and had pulmonary tuberculosis (74.2%). Bacteriological tests were performed on 59.8% of children, where 21.6% had positive bacteriological results. Bacteriologically confirmed TB was higher in children over 5 years (29.5%), pulmonary TB (25.6%), and retreatment (28.6%). The majority of children (84.2%) completed treatment, while 10.7% were cured, 1.5% were lost to follow-up, 3.1% died, and 0.5% failed treatment. Overall, unsuccessful treatment outcome was 5.1% while successful treatment outcome was 94.1%. Extrapulmonary tuberculosis was associated with unsuccessful treatment outcomes (AOR 1.64; 95% CI: 1.02-2.62). The tuberculosis successful treatment outcome met the World Health Organization's threshold goal of 90%. Children with extrapulmonary tuberculosis should be targeted as a high-risk group to improve treatment outcomes. Tracking children whose treatment outcomes were not evaluated would provide more precise estimates of TB treatment outcomes.

Role of mothers in preventing tuberculosis in children: A scoping review

Tuberculosis (TB) remains a significant global health challenge, especially for children. The aim of this scoping review was to investigate the role of mothers in preventing childhood TB transmission and highlight effective strategies and associated barriers. A systematic literature search was conducted using PubMed, Web of Science, and Scopus, covering articles up to January 17, 2024. The search included keywords like “mother,” “parents,” “care,” “prevention,” and “tuberculosis.” Eligibility criteria included peer-reviewed articles on maternal health interventions for TB prevention in children and published in English. The study selection process involved screening titles and abstracts, followed by full-text reviews by Rayyan Artificial Intelligence (AI). Eighteen studies were analyzed, revealing the crucial roles of mothers and healthcare workers in TB prevention. The results indicated that in South Africa, only 47% of eligible pregnant women underwent Mantoux testing, with lower rates in rural areas. The isoniazid preventive therapy (IPT) uptake rate was 79%, with geographical variations. Barriers included insufficient patient information, inadequate screening facilities, and healthcare providers' knowledge gaps. Parental involvement, particularly by mothers, is vital for adherence to TB preventive measures. Challenges in integrating TB case-finding with antenatal care and prevention of mother-to-child transmission (PMTCT) services included inconsistent screening and healthcare worker shortages. Enhancing health services, reducing stigma, and integrating TB prevention into existing programs are essential. In conclusion, this review underscores that effective childhood TB prevention requires a coordinated approach that incorporates the efforts of the mother and healthcare worker. Addressing barriers such as contact tracing gaps and diagnostic delays, alongside enhancing maternal health education and support, is essential for improving TB prevention and management. Targeted interventions and collaborative efforts are needed to reduce transmission and improve health outcomes, particularly in bridging rural-urban disparities.

Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia.

Data on childhood and adolescent multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in Indonesia are lacking. We aimed to assess clinical features, adverse events (AEs) and treatment outcomes of childhood and adolescent MDR/RR-TB. A retrospective cohort study was performed in children and adolescents aged <18 years treated for MDR/RR-TB at Hasan Sadikin General Hospital in Bandung, Indonesia, between June 2016 and March 2024. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for predictors of all-cause mortality. Among 84 included patients, 69 (82%) were adolescents aged 10-17 years, 54 (64%) were female, 54 (64%) were malnourished and 55 (65%) had culture-confirmed disease. Among 69 (82%) patients with known outcomes, 48 (70%) were successfully treated, 14 (20%) died (including 5 pretreatment deaths) and 7 (10%) were lost to follow-up (LTFU) (including 5 pretreatment LTFU). Predictors of all-cause mortality included shortness of breath on admission [aOR: 6.4, 95% confidence interval (CI): 1.3-49.1], high bacillary burden on Xpert MTB/RIF assay (aOR: 17.0, 95% CI: 1.6-260.5) and the presence of lung cavities on chest radiograph (aOR: 4.8, 95% CI: 1.1-23.3). Among 74 patients who initiated treatment, 39 (53%) had at least one grade 1-2 AE, and 4 (5%) had one grade 3-4 AE each, including hepatotoxicity, QT prolongation, hearing loss and rash/hyperpigmentation. Younger children were underrepresented among those treated for MDR/RR-TB, indicating reduced access to care. Severe AEs were uncommon during MDR/RR-TB treatment. Baseline indicators of extensive disease were associated with all-cause mortality. The high proportion of pre-treatment mortality and LTFU may reflect complex patient pathways limiting access to care.

PANORAMA EPIDEMIOLÓGICO DA TUBERCULOSE EM CRIANÇAS E ADOLESCENTES NO BRASIL: ANÁLISE DE CASOS NOTIFICADOS ENTRE 2003 E 2023.

Tuberculosis (TB) remains a significant public health issue in Brazil, particularly among children and adolescents. This study aims to conduct a retrospective analysis of the epidemiological profile of TB cases reported in the population aged 0 to 19 years between 2003 and 2023, focusing on diagnosis and follow-up. It is a descriptive and analytical study with a quantitative approach, utilizing data extracted from the Notifiable Diseases Information System (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). A total of 163,262 TB cases were analyzed, of which 55.1% were female and 44.8% were male. The majority of cases were concentrated in the 15 to 19 age group, and the distribution by race/color showed a predominance of mixed-race individuals. A general decline in the number of cases was observed over the years, with a significant reduction between 2020 and 2021. However, the incidence of TB in children under 1 year of age increased gradually. Regarding diagnosis, only 51.87% of cases were confirmed by laboratory tests, with low rates of sputum culture and bacilloscopy. Cure and treatment adherence rates remained stable until 2021 but dropped dramatically in 2023. The study concludes that there are significant challenges in the early diagnosis and management of TB in this population, suggesting the need for more effective public policies to improve health outcomes and reduce TB-related mortality among children and adolescents.

Immunoproteomic discovery of Mycobacterium bovis antigens, including the surface lipoprotein Mpt83 as a T cell antigen useful for vaccine development

Tuberculosis (TB) is one of the leading causes of death from infectious diseases, killing approximately 1.3 million people worldwide in 2022 alone. The current vaccine for TB contains a live attenuated bacterium, Mycobacterium bovis BCG (Bacille Calmette-Guérin). The BCG vaccine is highly effective in preventing severe forms of childhood TB but does not protect against latent infection or disease in older age groups. A new or improved BCG vaccine for prevention of pulmonary TB is urgently needed.In this study, we infected murine bone marrow derived dendritic cells from C57BL/6 mice with M. bovis BCG followed by elution and identification of BCG-derived MHC class I and class II-bound peptides using tandem mass spectrometry. We identified 1436 MHC-bound peptides of which 94 were derived from BCG. Fifty-five peptides were derived from MHC class I molecules and 39 from class II molecules. We tested the 94 peptides for their immunogenicity using IFN- γ ELISPOT assay with splenocytes purified from BCG immunized mice and 10 showed positive responses. Seven peptides were derived from MHC II and three from MHC class I. In particular, MHC class II binding peptides derived from the mycobacterial surface lipoprotein Mpt83 were highly antigenic. Further evaluations of these immunogenic BCG peptides may identify proteins useful as new TB vaccine candidates.

Combination of serological and cytokine release assays for improved diagnosis of childhood tuberculosis in Zambia (PROMISE-TB)

ObjectivesThe diagnostic gaps for childhood tuberculosis (TB) remain considerable in settings with high TB incidence and resource constraints. We established and evaluated the performance of a scoring system based on a combination of serological tests and T-cell cytokine release assays, chosen for their ability to detect immune responses indicative of TB, in a context of high prevalence of pediatric HIV infection. MethodsWe enrolled 628 consecutive children aged ≤15 years, admitted for TB suspicion. Multiple cytokine levels in QuantiFERON Gold In-Tube supernatants and antigen 85B (Ag85B) antibodies were assessed in children who tested positive with either Xpert TB or mycobacterial culture. The results were compared with those of control children. ResultsAmong the biomarkers most strongly associated with TB, random forest classification analysis selected Ag85B antibodies, interleukin-2/interferon-γ ratio, and monokine induced by interferon-γ for the scoring system. The receiver operating characteristic curve derived from our scoring system showed an area under the curve of 0.95 (0.91-0.99), yielding 91% sensitivity and 88% specificity. The internal bootstrap validation gave the following 95% confidence intervals for the score performance: sensitivity 71%-97% and specificity 79%-99%. ConclusionsThis study suggests that supplementing the QuantiFERON assay with a combination of serological and T-cell markers could enhance childhood TB screening regardless of HIV status and age. Further validation among the target population is necessary to confirm the performance of this scoring system.

Integration and validation of host transcript signatures, including a novel 3-transcript tuberculosis signature, to enable one-step multiclass diagnosis of childhood febrile disease

BackgroundWhole blood host transcript signatures show great potential for diagnosis of infectious and inflammatory illness, with most published signatures performing binary classification tasks. Barriers to clinical implementation include validation studies, and development of strategies that enable simultaneous, multiclass diagnosis of febrile illness based on gene expression.MethodsWe validated five distinct diagnostic signatures for paediatric infectious diseases in parallel using a single NanoString nCounter® experiment. We included a novel 3-transcript signature for childhood tuberculosis, and four published signatures which differentiate bacterial infection, viral infection, or Kawasaki disease from other febrile illnesses. Signature performance was assessed using receiver operating characteristic curve statistics. We also explored conceptual frameworks for multiclass diagnostic signatures, including additional transcripts found to be significantly differentially expressed in previous studies. Relaxed, regularised logistic regression models were used to derive two novel multiclass signatures: a mixed One-vs-All model (MOVA), running multiple binomial models in parallel, and a full-multiclass model. In-sample performance of these models was compared using radar-plots and confusion matrix statistics.ResultsSamples from 91 children were included in the study: 23 bacterial infections (DB), 20 viral infections (DV), 14 Kawasaki disease (KD), 18 tuberculosis disease (TB), and 16 healthy controls. The five signatures tested demonstrated cross-platform performance similar to their primary discovery-validation cohorts. The signatures could differentiate: KD from other diseases with area under ROC curve (AUC) of 0.897 [95% confidence interval: 0.822–0.972]; DB from DV with AUC of 0.825 [0.691–0.959] (signature-1) and 0.867 [0.753–0.982] (signature-2); TB from other diseases with AUC of 0.882 [0.787–0.977] (novel signature); TB from healthy children with AUC of 0.910 [0.808–1.000]. Application of signatures outside of their designed context reduced performance. In-sample error rates for the multiclass models were 13.3% for the MOVA model and 0.0% for the full-multiclass model. The MOVA model misclassified DB cases most frequently (18.7%) and TB cases least (2.7%).ConclusionsOur study demonstrates the feasibility of NanoString technology for cross-platform validation of multiple transcriptomic signatures in parallel. This external cohort validated performance of all five signatures, including a novel sparse TB signature. Two exploratory multi-class models showed high potential accuracy across four distinct diagnostic groups.

Pediatric Tuberculosis Screening through Parent Involvement

Introduction: Tuberculosis (TB) remains a significant public health concern, particularly in developing countries. Pediatric TB poses a unique challenge due to the difficulty in diagnosing the disease in young children. Early detection and treatment of TB are crucial to prevent transmission and improve outcomes. Parent involvement in pediatric TB screening can be vital in increasing case detection and reducing morbidity and mortality. Objectives: This study aims to investigate the effectiveness of pediatric TB screening through parent involvement in a community setting in Indonesia. The study will assess this approach's feasibility, acceptability, and impact on identifying TB cases among children. The findings will contribute to developing effective strategies for pediatric TB screening in resource-limited settings. Methods: The research used a pre-and post-test design with a control group design involving 177 mothers with children aged 0-14 years in the Seberang Health Center Working Area, Padang City. Three interventions were applied: self-screening education, structured training, and self-screening simulation. Results: The intervention group showed notable improvements in knowledge, understanding, confidence, and skills across all stages, with statistically significant results (p &lt; 0.05). In contrast, the control group experienced either minimal improvements or decreases in these areas. These findings suggest that the comprehensive approach of education, training, and simulation-based interventions is highly effective in enhancing parents' capacity for early detection of childhood tuberculosis, offering a promising solution for preventing and managing the disease. Conclusions: The results showed significant improvements in mothers' knowledge, understanding, and skills, with each approach contributing differently. The implications are substantial, providing practical guidance for the implementation of TB self-screening in communities and changing the paradigm of TB detection in children nationally and globally.

The Particularities of Pulmonary Tuberculosis in Children with Type 1 Diabetes: About 2 Cases

The combination of pulmonary tuberculosis and type 1 diabetes is a significant public health problem, especially in developing countries, where the incidence of both diseases is rising sharply. According to the World Health Organization (WHO), by 2022, 23% of tuberculosis cases will be in Africa. Morocco is one of the countries with a medium incidence of tuberculosis. The Ministry of Health has launched a national strategic plan for the prevention and control of tuberculosis. However, there is no national study on the prevalence of tuberculosis in diabetic children in Morocco. Several studies in the literature have investigated the specifics of this association, and have shown that there is a two-way association between tuberculosis and type 1 diabetes. Latent tuberculosis is most common in diabetic children, while active tuberculosis can give rise to severe and atypical presentations. In this study 2 cases have been reported of type 1 diabetes associated with pulmonary tuberculosis, of varying severity, in a 15-year-old child known to be diabetic and an 18-month-old infant with inaugural diabetes, in order to determine the clinical, paraclinical, therapeutic and evolutionary particularities of tuberculosis in these children.

Spatial analysis of tuberculosis cases among stunted toddlers in Rambipuji District, Jember Regency

Background: The ongoing prevalence of tuberculosis (TB) and stunting presents significant health challenges, frequently localized within specific regions of Indonesia. Spatial analysis is essential in controlling infectious diseases like TB, as it identifies disease clusters and patterns of local TB spread within an area. Objective: This study aimed to analyze the distribution of TB cases among stunted children through spatial analysis. Methods: We used a cross-sectional analytical descriptive study. We interviewed parents of stunted children using a questionnaire. The diagnosis of TB was made based on the pediatric TB scoring table. Coordinate data of sample sites were obtained using a Geographic Information System (GIS), supported by risk factor analysis of TB. We then created a disease distribution map using the spatial analysis by Moran's Index and Nearest Neighbor Index (NNI) methods. Results: There were 15 childhood TB cases (8.2%) among stunted children in Rambipuji District. The spatial autocorrelation test using Moran's index showed that TB cases were clustered in Rambigundam village (Moran’s index 0.2364, p-value &lt;0.05 and Z-score &gt;1.96). The results of the NNI analysis showed dispersed results (p-value=0.000) in all villages. Conclusion: The distribution of childhood TB cases among stunted children in Rambipuji District is primarily random, except for Rambigundam Village, which shows a clustering of cases. According to the NNI methods, childhood TB cases among stunted children are spreading throughout all villages. These results underscore the need for initiatives to curb TB transmission, especially among stunted children, which should be targeted at all villages.

SARS-CoV-2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited. A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups. Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group. Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.

Navigating complex care pathways-healthcare workers' perspectives on health system barriers for children with tuberculous meningitis in Cape Town, South Africa.

Tuberculous meningitis (TBM) occurs when tuberculosis (TB) bacilli disseminate and seed into the meninges, triggering a severe inflammatory response that often leads to brain infarction. It is the most severe and debilitating form of childhood TB with high mortality, and children who survive TBM often suffer lifelong physical and neuro-disability resulting in emotional, social, and economic burdens for families. In the early stages the symptoms may be non-specific and so the diagnosis is often made late when the patient already has significant brain injury. To facilitate earlier diagnosis, it is important to understand how patients are evaluated. This study aimed to chart health systems for paediatric TBM care at both primary healthcare (PHC) and hospital level in Cape Town, South Africa. We conducted fourteen in-depth interviews and eight days of semi-structured observations of patient flow across eight healthcare facilities. We found that children with TBM navigate multiple levels of care categorised into pre-admission and primary care, hospital admission and inpatient care, and post-discharge follow-up care. Healthcare workers identified the following health system barriers along the TBM care pathway for children: limited post-training and mentorship opportunities to manage TBM, overburdened facilities, time constraints, lack of recognition of TBM symptoms, delays in referral between PHC and hospital, lack of standardized diagnostic algorithms, limited diagnostic tests and a lack of child-friendly, easy-to-administer treatment. Regular and compulsory training on TB and TBM in children, including continuous mentoring and support to healthcare workers working in child health and TB services in high TB-burden settings, can facilitate early recognition of symptoms and rapid referral for diagnosis. Algorithms outlining referral criteria for patients with possible TBM at both PHC facilities and district level hospitals can guide healthcare providers and facilitate timely referral between different levels of healthcare services. An integrated data system and alert functions could flag multiple healthcare visits and improve communication between different healthcare facilities during diagnosis and treatment. Children and families affected by TBM are an especially vulnerable sub-population requiring high priority attention and support.

Situation on childhood tuberculosis for 10 years and the organization of pediatric tB service in St. petersburg

Situation on childhood tuberculosis for 10 years and the organization of pediatric tB service in St. petersburg