Pediatric Tuberculosis Patients Research Articles

Clinical characteristic, common sites, and geographical distribution of pediatric tuberculosis patients in Southwest China.

The data report of a large sample, dynamic epidemiology, and characteristic analysis of pediatric tuberculosis (TB) in Southwest China is not clear. Herein, we conducted descriptive dynamic epidemiology, characteristic analysis and geographical distribution study of pediatric TB inpatients in Southwest China for more than 20 years. Patients with pediatric TB were recruited from October 2002 to September 2022 in Southwest of China based on etiology or clinical confirmation. Extract hospitalization medical record information for each patient. The geographical distribution chart of cases is used to display the trend of case flow segmented every 5 years. Among 3,024 pediatric TB patients with an average age of 9.11 ± 4.39, 17.49% (529) had pulmonary tuberculosis (PTB), 9.06% (274) had extrapulmonary tuberculosis (EPTB), and 73.45% (2,221) had combined TB. The most common form of EPTB is disseminated TB (28.98%), followed by TB lymphadenitis (20.56%), pleural TB (19.72%), and TB meningitis (19.68%). Children aged 0-4 years had a high risk of TB meningitis and a severe symptoms, while children in the elderly age group had a high risk of pleural TB. In the past 20 years, hospitalized TB pediatric cases mainly came from Sichuan, Tibet, Qinghai, Yunnan and other places. The number of patients from ethnic minorities, especially Tibetans, showed an upward trend on a yearly basis (χ2 = 401.43, P < 0.001). Public health investment and effective management in pediatric TB should be further strengthened.

CHILDHOOD TUBERCULOSIS: STUDY OF CLINICAL PROFILE OF TUBERCULOSIS IN PEDIATRIC PATIENTS AND CORRELATION OF CB-NAAT RESULT IN CLINICALLY SUSPECTED TUBERCULOSIS

Introduction: Tuberculosis is a chronic infectious disease caused by predominantly Mycobacterium tubercle bacilli. Pediatric tuberculosis is among the top 10 causes of death in children. India accounts for one fourth of the global tuberculosis burden, standing one among the thirty high TB burden countries. Hence, children in India are at increased risk of acquiring TB infection and developing TB disease and death following infection. Latent TB infection in children may be reactivated in later life and become active adulthood tuberculosis and thereby a potent TB reservoir in the community. Aim: To study clinical profile of tuberculosis in pediatric patients and correlation of CB-NAAT result in clinically suspected tuberculosisat tertiary care center. Method: Prospective Observational study from1 August 2020 to 31 August 2022. Result: Out of 52 patients cough was presenting symptom of 19(36.53%), fever was present in 25(48.07%), loss of weight &gt;5% in last 3 month was present in 12(23.07%),fever(83.8 %) was most dominant symptom. Out of 52 patients, tachypnoea was presenting sign in 5(9.6%), ascites was present in 5(9.6%) and lymphadenopathy for more than 2 weeks were present in 25(48.07%). Out of 52 patients Anaemia was present in 42(80.76%), High ESR was present in 22(42.30%) and Mantoux test was positive in 16(30.76%). Conclusion: Reliable diagnosis of tuberculosiscan be done by clinical parameters like presence of tachypnea, fever and lymphadenopathy. CB NAAT in correlation to clinical parameters is very useful for diagnosis of tubercular cases.

Obstáculos no combate à tuberculose multidroga resistente em pacientes pediátricos: uma revisão de escopo

Abstract Objectives: to identify the scientific evidence on excessively resistant and multidrug resistant tuberculosis in pediatric patients. Methods: this is a scope review of the literature, with a guiding question: “What is the scientific evidence on multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis in pediatric patients?”. The research used the descriptors: “extensively drug-resistant tuberculosis” OR “multidrug-resistant tuberculosis” AND “pediatrics”. The research was carried out in a double-blind manner in the following databases of the Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific’s Institutional Repository for Information Sharing, Embase/Elsevier and International Clinical Trials Registry Platform, with a temporal cut-off from 2011 to 2021, sending a final synthesized sample of 18 articles, which evaluated the methodological content through the level of evidence. Results: the results show the lack of research with a high level of evidence related to MDR-TB in children, the lack of adequate dosage of second-line drugs for the pediatric population and the importance of drug sensitivity testing for the cases of treatment Conclusions: it was identified that the obstacles to MDR-TB treatment were concentrated in the lack of detailed protocols, safe drug dosages with a low side effect, and mainly in the social health determinants and disease process involving MDR-TB.

Obstacles in combating multidrug resistant tuberculosis in pediatric patients: a scope review

Resumo Objetivos: identificar as evidências científicas sobre tuberculose excessivamente resistente e multidroga resistente em pacientes pediátricos. Métodos: trata-se de uma revisão de escopo da literatura, tendo como questão norteadora: “Quais as evidências científicas sobre tuberculose multidroga-resistente (TB-MDR) e tuberculose extensivamente resistente em pacientes pediátricos?” A pesquisa usou os descritores: “tuberculose extensivamente resistente a medicamentos” OR “tuberculose resistente a múltiplos medicamentos” AND “pediatria”. A pesquisa foi realizada de modo duplo-cego nas bases de dados Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific’s Institutional Repository for Information Sharing, Embase/Elsevier e International Clinical Trials Registry Platform, com um corte temporal de 2011 a 2021, sendo a amostra final sintetizada de 18 artigos, nos quais avaliou-se o conteúdo metodológico por meio do nível de evidência. Resultados: os resultados mostraram a escassez de pesquisas de alto nível de evidência relacionadas à TB-MDR em crianças, ausência de posologia adequada das drogas de segunda linha para o público pediátrico e a importância do teste de sensibilidade a drogas para o tratamento dos casos. Conclusões: identificou-se que os obstáculos do tratamento TB-MDR se concentraram na ausência de protocolos detalhados, de dosagens medicamentosas seguras e com menor efeito colateral, e, principalmente, nos determinantes sociais do processo saúde e doença que envolvem a TB-MDR.

Analysis Of The Nutritional Status Of Pediatric Tuberculosis Patients After Treatment At The X General Hospital Center

Introduction: Indonesia is currently ranked 2nd in the country with the highest number of tuberculosis (TB) cases. TB disease in children cannot be separated from the role of nutritional status. Poor nutrition can cause immunological disorders and affect the disease healing process. Methodology: The research method used was cross-sectional which was carried out at Central General Hospital X in July 2019. A sample of 72 pediatric tuberculosis patients was taken using a simple random sampling technique. The data used is secondary data from medical records for the period January 2016-December 2018 to look at the characteristics of pediatric TB patients and analyze the evaluation of nutritional status after treatment. Data analysis used the non-parametric Wilcoxon test. Results: The highest age was in the 5-14 year category (51.4%). In the Wilcoxon test, a p-value of 0.000 (&lt;0.05) was obtained, which stated that there was a significant difference between nutritional status before and after treatment. Conclusion: Compliance with pediatric TB patients in undergoing treatment will improve the patient’s nutritional status.

Assessment of Factors Associated With Anti-Tubercular Treatment Compliance in Children: A Cross-Sectional Study.

Objective. This study aims to investigate compliance and the influencing factors related to pediatric tuberculosis patients who are undergoing treatment with anti-tuberculosis drugs in the Sichuan Province of China. Methods. A questionnaire survey was conducted between March 2019 and March 2021. The survey was distributed to caregivers of children aged 0 to 14 who had been diagnosed with pulmonary tuberculosis. These children had been receiving oral anti-tuberculosis drug treatment for more than 1 month. The survey was administered at the pediatric infection departments of West China Second University Hospital, Sichuan University, and The First People's Hospital of Ganzi Prefecture. Results. The study revealed a notable lack of medication adherence among the pediatric patients. Through multiple linear regression analysis, it was determined that several factors played a role in influencing medication adherence among children with tuberculosis. These factors include the educational level of the parents, the frequency of daily anti-tuberculosis drug prescriptions, and the parents' comprehension of the disease. All of these factors showed statistically significant influence on medication adherence among pediatric tuberculosis patients (all P < .05). Conclusion. In order to enhance adherence among pediatric patients undergoing anti-tuberculosis treatment, it is imperative to focus on reinforcing health education, particularly for parents with lower educational attainment and limited understanding of the disease.

Incidence of Rifampicin-Resistant Strains in Pediatric Cases Newly Identified with Pulmonary Tuberculosis

Background: To assess the effect of rifamycin prevalence which create resistant in newly diagnosed pediatric patients having pulmonary infections. Objectives: This scientific research was conducted to evaluate the prevalence of antibiotics resistivity in pediatric children specifically under age. The primary antibiotics were found to be resistant when given to children at the onset of disease. The investigation was done to evaluate the efficacy of the rifamycin antibiotic as treatment option which will excite the comprehension of drug resistant tuberculosis in pediatric population under the specific age. Study Design: Cross sectional study. Settings: The study was conducted in Children Hospital, Lahore Pakistan. Duration: The study was conducted duration the time period staring from 24 May 2023 to 23 November 2023. Methods: The current study was conducted under the criteria of cross-sectional information to assess the antibiotics resistant in bacterial pathogens among the chronic disease as tuberculosis patient specifically children. The evaluation was purely done on the basis of statistical analysis by using statistical tools to examine the gender base medication relevant factors involved in occurring of disease. the resistivity was identified with particular factors. The evaluation was done on behalf of statistical tools SPSS version 23. Results: The current research offers the valuable insight the prevalence of antibiotics rifamycin resistivity in the children with the disease of lungs like tuberculosis or other lungs issues regarding to bacterial infection. The suitable treatment strategies were made, and drug resistant was confirmed. Conclusion: The study undergoes the prevalence of the drug resistant bacterial infection caused by specifically limitation of drugs effectivity against bacteria. The elevated resistant rate rephasing the necessity to explore the alternativity for the effective prevention and management of drug resistant tuberculosis in pediatric patients.

OVERVIEW OF CHEST RADIOGRAPH AND CLINICAL SYMPTOMS OF PEDIATRIC PULMONARY TUBERCULOSIS PATIENT IN PROF. DR. I.G.N.G NGOERAH HOSPITAL JANUARY 2021 – JUNE 2022

Tuberculosis (TB) is an infectious disease whose incidence is still quite high in Indonesia. The increasing incidence of pediatric pulmonary TB is still happening today. The diagnosis of pediatric pulmonary TB is still a hot topic because the chest radiograph and clinical symptoms are not typical and are often found in other diseases. The aim of the research is to know the overview of chest radiograph and clinical symptoms of pediatric pulmonary TB patients. This research was conducted at Prof. RSUP. Dr. I.G.N.G Ngoerah January 2021 – June 2022 using a cross-sectional descriptive method and medical record data as source with total sample is 30 people. Univariate analysis was performed using the Statistical Package for the Social Science (SPSS) version 26.0 for MacOS. The results of the study are majority of pediatric pulmonary TB patients at RSUP Prof. Dr. I.G.N.G Ngoerah January 2021 – June 2022 is female (60%), age group 11-16 years (50%), abnormal chest radiograph (96.7%), asymptomatic (63.3%), lymphadenopathy of hilar/paratracheal lymph nodes with/without parenchymal consolidation (96.7%), cough symptoms (30%). Children with pulmonary TB at RSUP Prof. Dr. I.G.N.G Ngoerah January 2021 – June 2022 is dominated by female gender, age group 11-16 years, abnormal chest radiograph, asymptomatic, lymphadenopathy of hilar/paratracheal lymph nodes with/without parenchymal consolidation and symptoms of cough.

Tuberculosis-targeted next-generation sequencing and machine learning: An ultrasensitive diagnostic strategy for paucibacillary pulmonary tuberculosis and tuberculous meningitis

BackgroundExisting diagnostic approaches for paucibacillary tuberculosis (TB) are limited by the low sensitivity of testing methods and difficulty in obtaining suitable samples. MethodsAn ultrasensitive TB diagnostic strategy was established, integrating efficient and specific TB targeted next-generation sequencing and machine learning models, and validated in clinical cohorts to test plasma cfDNA, cerebrospinal fluid (CSF) DNA collected from tuberculous meningitis (TBM) and pediatric pulmonary TB (PPTB) patients. ResultsIn the detection of 227 samples, application of the specific thresholds of CSF DNA (AUC = 0.974) and plasma cfDNA (AUC = 0.908) yielded sensitivity of 97.01 % and the specificity of 95.65 % in CSF samples and sensitivity of 82.61 % and specificity of 86.36 % in plasma samples, respectively. In the analysis of 44 paired samples from TBM patients, our strategy had a high concordance of 90.91 % (40/44) in plasma cfDNA and CSF DNA with both sensitivity of 95.45 % (42/44). In the PPTB patient, the sensitivity of the TB diagnostic strategy yielded higher sensitivity on plasma specimen than Xpert assay on gastric lavage (28.57 % VS. 15.38 %). ConclusionsOur TB diagnostic strategy provides greater detection sensitivity for paucibacillary TB, while plasma cfDNA as an easily collected specimen, could be an appropriate sample type for PTB and TBM diagnosis.

ВОЗРАСТНЫЕ ОСОБЕННОСТИ ФОРМИРОВАНИЯ ВНЕКЛЕТОЧНЫХ ЛОВУШЕК НЕЙТРОФИЛОВ У ЗДОРОВЫХ ЛИЦ И БОЛЬНЫХ ТУБЕРКУЛЁЗОМ

Abstracts. Introduction. Forming a neutrophil extracellular trap (NET) from DNA (NETosis) is considered as a potentially significant marker in the diagnosis of tuberculosis. However, there is practically a lack of data regarding the age-related differences in forming extracellular traps in research publications. Aim. To determine the age-related differences of NETosis in healthy individuals and in tuberculosis (TB) patients. Materials and Methods. The ability of neutrophils to form extracellular traps was investigated in 4 groups: 1) 4-7-year-old children diagnosed with the primary tuberculosis complex, who fell ill within Omsk region; 2) healthy and uninfected children at the same age; 3) adults with tuberculosis, and 4) adults without tuberculosis. For this purpose, isolated fractions of neutrophils from peripheral blood of the groups under research were stimulated with a mixture of bacteria (probiotic) for 30 minutes. In the hanging-drop preparation, we analyzed the proportion of neutrophil extracellular traps and cells in the state of various motility degrees. Results and Discussion. Age-related differences in the ability of neutrophils to form extracellular traps were characterized by a more pronounced response of neutrophils to the NETosis stimulant in children in the control group in comparison with neutrophils isolated from blood in the group of healthy adult volunteers: Neutrophils of children (Me=16.1; Q1=12.8; Q3=18.3) were statistically significantly more intense (p=0.0002) than those of adults (Me=8.6; Q1=7.1; Q3=10.5) and formed filamentous NETs. In the groups of pediatric and adult pulmonary TB patients, the response of neutrophils to the NETosis stimulant was diametrically opposite. Neutrophils of children with primary tuberculosis complex, as of those in the control group, predominantly formed filamentous NETs, but in greater amounts, while neutrophils of adults with infiltrative or focal form and with at most 2 segments involved mainly formed cloudy NETs, whereas filamentous NETs prevailed for the adults in the control group after stimulation. At the same time, proportion of cloudy NETs did not exceed 5% in healthy children and healthy adults. Comparing the findings of our study with literature data, we hypothesized that, most likely, there is a greater increase in PAD4 expression and more pronounced histone H3 citrullination in children’s neutrophils than in those of adults. Conclusions. Our findings indicate more pronounced ex vivo processes induced by NETosis stimulator in both groups of children (healthy individuals and TB patients) as compared to adults in the respective groups, which should be considered by the researchers interpreting the findings of the ability of neutrophils to form extracellular traps in tuberculosis.

Characteristics of Pediatric Tuberculosis Patients at Simpang Lima Gumul Hospital, Kediri, East Java

Introduction: Pediatric tuberculosis can cause a variety of problems, including growth failure, disability, and death. In 2021, WHO recorded 10.6 million individuals had tuberculosis globally, with pediatric tuberculosis accounting for 11% of these cases. Indonesia is the second highest high-burden country for tuberculosis, according to the WHO. Children with tuberculosis often present non-specific and uncommon symptoms, making diagnosis challenging and frequently delayed. This study aims to present an overview of the characteristics of pediatric tuberculosis patients at Simpang Lima Gumul Hospital in Kediri, East Java. Material and Methods: This was a descriptive retrospective study with a cross-sectional method. Pediatric tuberculosis patients who received treatment at the Simpang Lima Gumul Hospital in Kediri, East Java, were the subject of research. We compiled pediatric tuberculosis patients' demographic data and clinical characteristics using medical records. Results: Sixty-one children included in the study. Most of them were male (56%) between 1 to 5 years old (52%). Seventy-two percent had a positive tuberculin skin test; chronic cough was noted in 69% of cases. An adult contact history of tuberculosis was reported in 64% of cases, while 61% had radiographic findings from TB. 52% also had fever, 51% had lymphadenopathy, and 72% had good nutritional status. Conclusion: Tuberculosis occurs most commonly in male children 1 to 5 years of age. The most common symptoms of pediatric tuberculosis include a positive tuberculin skin test, chronic cough, contact with adults with tuberculosis, positive radiographic findings, fever, and lymphadenopathy.

Differences in epidemiological and clinical features between adult and pediatric tracheobronchial tuberculosis patients in Southwest China.

Tracheobronchial tuberculosis (TBTB) is a common form of extrapulmonary tuberculosis that affects the tracheobronchial tree. However, the mechanism has not been fully elucidated. Comparisons of clinical characteristics in various age groups can aid in the understanding of TBTB. This retrospective study was conducted at the Public Health Clinical Center of Chengdu between July 2017 and December 2021, including adults and children with TBTB. Clinical data were extracted from medical records. T/T' test, Mann-Whitney U test, Chi-square test, or Fisher's exact test were used in this study. This study enrolled 347 patients with TBTB (175 adults and 172 children). Adult females were more susceptible to TBTB, whereas gender-based differences were not observed in children. Children had a higher occurrence of irritant dry cough and fever, and acute hematogenous disseminated PTB, and specific types of EPTB, but a shorter interval before diagnosis, and lower diagnostic yields compared to adults (P < 0.05). Adults presented more extensive lung lesions and cavitations as compared to children. Granulation hyperplasia and lymph fistula were more frequently observed in children, as well as airway stenosis, but less severe. The study revealed important variations exist in multiple respects between adults and children with TBTB.

Serum Vitamin D Levels in Pediatric Tuberculosis Patients in a Tertiary Care Center in India: A Case-Control Study.

Background Mycobacterium is certainly one individual organism contributing to the most deaths of children among the world's lower- and medium-income nations. According to earlier studies, vitamin D insufficiency is one of the risk factors. We undertook this study since very few case-control studies are present. This study aimed to evaluate the role of vitamin D in tuberculosis (TB). Methods This case-control study was carried out in a tertiary care center at Niloufer Hospital over a period of one year and five months. The sample size was 140. SPSS (Statistical Package for the Social Sciences) Version 19 (IBM Corp., Armonk, NY) was used for statistical analysis. Two-tailed p-values and odds ratios were obtained. The chi-square test was applied to differentiate between two categorical variables. For means, the Student t-test was applied. We usually take baseline investigations before starting ATT (anti-TB treatment) with the blood sample we tested for vitamin D levels. Results With p-values of 0.767 and 0.866, the age and sex distributions in the cases and controls were comparable. Rural and urban area distribution and malnutrition distribution were not similar in both groups, with a p-value of 0.001. The mean vitamin D level in cases was 10.4, while controls it was 22.8, and this difference is statistically significant (p = 0.001). Conclusion Vitamin D deficiency is more common in children with TB than in normal children. In addition, a severe form of vitamin D deficiency (less than 10 ng/mL) was higher among children with TB. Clinicians should be aware of associated malnutrition and low socioeconomic status as risk factors for severe vitamin D deficiencies among them.

"Cutaneous Tuberculosis in Pediatric Patients with Primary Immunodeficiency Report of 3 Cases"

"Cutaneous Tuberculosis in Pediatric Patients with Primary Immunodeficiency Report of 3 Cases"

Serum Levels of Interleukin-12 and Interferon Gamma in Pediatric Tuberculosis: A Clinico-Microbiological Correlation

Objective: The interleukin-12/interferon-γ (IL-12/IFN-γ) pathway is the most validated cytokine pathway regulating Mycobacterium tuberculosis infection. The role of IL-12/IFN-γ axis in protecting against tuberculosis (TB) is exhibited in people having mutations in genes encoding these cytokines. We aimed to study the serum levels of IL-12 and IFN-γ in pediatric tuberculosis and their correlation with clinical and microbiological features. Material and Methods: A case-control study was conducted on 60 microbiologically confirmed (smear and/or culture and/or cartridge-based nucleic acid amplification test) or clinically diagnosed (based on clinical features and radiography and/or contact history and/or Mantoux test with/without microbiological confirmation) pediatric TB patients ≤12 years. Serum interleukin-12 and interferon-gamma levels were estimated using enzyme-linked immunosorbent assays.Thirty age- and sex-matched controls were also included in the study. Results: The median IL-12 levels were lower in our pediatric TB patients (488.1 pg/ml) compared to controls (784.8 pg/ml). However, the IFN-γ/IL-12 ratios were significantly higher among the TB patients as compared to the controls. Moreover, the levels of interleukin-12 and interferon gamma were significantly lower in cases with no evidence of TB on chest radiography. IL-12 was significantly lower in patients with hydrocephalus and enlarged ventricles. Higher levels of IL-12 and IFN-γ were associated with positive results by conventional microbiological techniques. Conclusion: The serum IFN-γ level and the IFN-γ/IL-12 ratio were significantly higher in children with TB compared to the controls in this study. Higher IL-12 and IFN-γ levels as well as IFN-γ/IL-12 ratios were associated with positive results by conventional microbiological techniques. Further studies on larger sample sizes could help evaluate the usefulness of interleukin-12 and interferon-γ as potential markers of severity and prognosis in pediatric TB. 

Parents Knowledge and Experiences of Child TB Patients about Medicine Administration in the Intensive Phase

BACKGROUND: Children with pulmonary tuberculosis (TB) who are undergoing intensive phase of treatment often experience negative things, resulting in disobedience in taking medication. Exploration of the experiences of pediatric TB patients in the treatment process needs to be known as information for management from the aspect of drug adherence. The role of parents in overcoming these problems is very important, so it is necessary to know the extent of their knowledge about pulmonary TB disease. METHODS: A qualitative study to explore the experiences of pediatric TB patients was conducted by interviewing 15 patients aged 8–12 years. In addition, a questionnaire was filled out to assess the knowledge about TB of the patient’s parents. The results of the recorded interviews were written and analyzed using the thematic method, while the results of the questionnaire from parents were analyzed descriptively. RESULTS: The results of the questionnaire showed that as many as ten respondents (66.6%) had a sufficient level of knowledge with 9 (60%). Analysis of the data using the Spearman rank test obtained a significance value (p) of 0.11 where p &lt; 0.05, which means there is no relationship between adherence to medication for pulmonary tuberculosis in children and the knowledge of parents in the intensive phase. CONCLUSION: Parental knowledge is sufficient or good does not guarantee that it can change the behavior of individuals or children in complying with the treatment in the intensive phase, although knowledge plays an important role in increasing adherence to taking medication in the intensive phase, there may be other factors that influence so that there is no relationship.

Characteristics and Risk Factors in Pediatric Tuberculosis Patients at Pasirian Hospital, Lumajang, East Java

Background: Tuberculosis is a disease caused by Mycobacterium tuberculosis. Malnutrition is also a significant risk factor in developing pediatric tuberculosis. Indonesia is one of the top four high-burden countries for tuberculosis listed by the WHO. The prevalence of pediatric tuberculosis is about 1% of the total population. However, the data on the majority of risk factors for pediatric tuberculosis in Indonesia is still scarce. Aim: This research aims to describe the risk factors for pediatric tuberculosis in Indonesia. Method: This is a single-centre, cross-sectional research involving pediatric tuberculosis patients who underwent treatment in Pasirian Hospital, East Java. We collected demographical data and risk factors for pediatric tuberculosis using questionnaires and data from medical records. Result: The most prevalent risk factors for pediatric tuberculosis is contact with the positive case (87.1%), Lymph node enlargement (77.4%), and positive radiological finding (74.2%). Conclusion: This study describes the risk factors associated with pediatric tuberculosis in Pasirian Hospital. The result of the study shows that most patients had contact with positive cases, enlarged lymph nodes, and positive radiological findings.

Results of the performance of automated GeneXpert in childhood tuberculosis in Addis Ababa, Ethiopia: a retrospective cross-sectional study

Background: Approximately 81% of all childhood tuberculosis cases occur among 22 high-burden countries and Ethiopia ranks eighth among these high burden countries. The GeneXpert Mycobacterium tuberculosis DNA and resistance to rifampicin (MTB/RIF) test can detect pediatric tuberculosis and its multidrug-resistant form with very high sensitivity and specificity, but limited data exists on its use in our country. We aimed to evaluate the effectiveness of the GeneXpert assay in comparison to children with a clinical diagnosis of Tuberculosis. &#x0D; Methods: A descriptive retrospective study on 144 TB-diagnosed children younger than 15 years was conducted at Tikur-Anbessa specialized hospital and Yekatit 12-referral hospital, pediatrics departments, Addis Ababa, Ethiopia. The performance of the GeneXpert test was evaluated by re-vising the charts of patients who have begun anti-tuberculosis treatment. We extracted information from the chart review of 144 eligible children who were diagnosed with tuberculosis and began anti-TB treatment from February 2014 to July 2016. &#x0D; Result: In the study, 144 patients with clinical diagnosis of tuberculosis were included, and 23% of them also had concurrent HIV infection. Equal numbers of male and female were present; 48.6% were from Addis Ababa. Thirty-four patients (23.6%) were missing their childhood vaccinations. The GeneXpert assay detected disease in only 24 (16.7%) of clinically diagnosed pediatric tuberculosis patients.&#x0D; Conclusion: Although the GeneXpert assay is helpful in the diagnosis of pediatric tuberculosis, most patients were still receiving treatment even after a negative GeneXpert test, necessitating the need for a more sensitive test.

A Mycobacterium tuberculosis fingerprint in human breath allows tuberculosis detection

An estimated one-third of tuberculosis (TB) cases go undiagnosed or unreported. Sputum samples, widely used for TB diagnosis, are inefficient at detecting infection in children and paucibacillary patients. Indeed, developing point-of-care biomarker-based diagnostics that are not sputum-based is a major priority for the WHO. Here, in a proof-of-concept study, we tested whether pulmonary TB can be detected by analyzing patient exhaled breath condensate (EBC) samples. We find that the presence of Mycobacterium tuberculosis (Mtb)-specific lipids, lipoarabinomannan lipoglycan, and proteins in EBCs can efficiently differentiate baseline TB patients from controls. We used EBCs to track the longitudinal effects of antibiotic treatment in pediatric TB patients. In addition, Mtb lipoarabinomannan and lipids were structurally distinct in EBCs compared to ex vivo cultured bacteria, revealing specific metabolic and biochemical states of Mtb in the human lung. This provides essential information for the rational development or improvement of diagnostic antibodies, vaccines and therapeutic drugs. Our data collectively indicate that EBC analysis can potentially facilitate clinical diagnosis of TB across patient populations and monitor treatment efficacy. This affordable, rapid and non-invasive approach seems superior to sputum assays and has the potential to be implemented at point-of-care.

Nodular Episcleritis in a Boy with Pulmonary Tuberculosis

Introduction: Episcleritis is an acute inflammation of the vascular connective tissue between the conjunctiva and the sclera’s surface, which can be found unilateral and bilateral. Tuberculosis (TB) is one of the systemic infectious diseases that cause morbidity in developing countries and can affect the ocular area known as ocular tuberculosis There are still limited cases of ocular tuberculosis studies, specifically tubercular nodular episcleritis in adolescents. This case report aims to expose nodular episcleritis in pediatric tuberculosis patients in Indonesia. Case Presentation: A 16-year-old boy came to the Community Eye Health Hospital East Java with superior bilateral eye redness and pain with normal visual acuity. He underwent advanced anti-tubercular treatment for the last nine months. The best corrected visual acuity (BCVA) of both eyes was 6/6. Slit-lamp biomicroscopy (SLB) examination found the dilation of blood vessels located on the superior episclera accompanied by a firmly bordered, fixed, pink nodule, diameter ± 1.5 mm located at 12 o’clock in bilateral bulbar conjunctiva. Based on anamnesis and physical examination, the diagnosis of nodular episcleritis et causa pulmonary TB was established. Topical corticosteroids and artificial tears eyedrops were given in both eyes for five weeks, and continuing anti-tubercular treatment was performed. Conclusion: It is necessary to investigate the primary cause of episcleritis by eliminating underlying systemic diseases. Herein, we present a rare case of nodular episcleritis in an adolescent with pulmonary tuberculosis who responded very well to anti-tubercular treatment with topical corticosteroid and artificial tears eye drops.