Tuberculosis Infection In Childhood Research Articles

Difficulties in diagnosing tuberculosis infection in childhood

Difficulties in diagnosing tuberculosis infection in childhood

Liver tuberculosis in children

Objective. The primary tuberculosis infection in childhood is manifested as a common disease. The diagnostics of liver tuberculosis is still a little-studied problem due to the absence of clinical manifestations.Purpose. To study clinical course, diagnostics and management of liver tuberculosis in children.Material and methods. 5 children, aged from 5 days to 16 years, with liver tuberculosis were under the observation. To put diagnosis, the researchers used the following parameters: anamnesis, examination, laboratory and specific tests, ultrasound, radiological methods including CT, biopsy of the surgical material.Results and discussion. Out of 5 children with liver tuberculosis, 3 had disseminated miliary pulmonary tuberculosis with liver damage; one had liver tuberculosis of the tuberculoma type and one had tumor-like liver tuberculosis. These three observations are described the article. In the diagnostics, basic indexes are CT of the abdominal organs, histological examination of the surgical material and positive Diaskin test.Conclusion. An isolated tuberculous liver damage is a rare case. More often, several anatomical regions are simultaneously involved in the specific process.

Design and Evaluation of Risk Assessment Tools to Identify Pediatric Tuberculosis Infection in Bohol, the Philippines, a Low-HIV- and High-TB-Burden Setting.

.Identifying children with, or at substantial risk of, Mycobacterium tuberculosis infection (TBI) and providing TB preventive therapy (TPT) represent an important, yet challenging, strategy in curbing the global burden of childhood TB. Risk assessment scoring tools, which quantify risks associated with unique factors characterizing an individual, could act as a surrogate measure of TBI risk and guide effective and efficient TPT delivery. We assessed important risk factors of childhood TBI and created risk assessment tools through secondary analysis of data from a large, community-based childhood TB prevalence study in the island province of Bohol in the Philippines, a low–HIV- and high–TB-burden, post-disaster setting. We identified four factors that were statistically associated with acquiring TBI—being 5 years or older, having a known TB contact, having a known TB contact who was either the mother or another primary caregiver, and living in a high–TB-burden municipality. We created 2-item, 4-item, and 9-item scores intended to identify child TBI in this low-resource, low–HIV-, and high–TB-burden setting. In addition to the design, evaluation, and impact analysis of these generalizable and valuable risk assessment tools, our study findings emphasize the necessity of targeting both household and community-associated transmissions of childhood TBI to achieve the global goal to end TB.

The Clinician's Toolkit: Laboratory Tests in the Diagnosis of Childhood Tuberculosis Infection and Disease

AbstractSmear microscopy and culture—the mainstay of tuberculosis (TB) diagnostics for the past century—fail to diagnose the majority of childhood TB cases. Promising new tests are becoming rapidly available, but their utility in childhood TB fails to surpass the accuracy of an astute clinician. In this review, we detail conventional and newer tests available for the diagnosis of TB infection and TB disease and their use in children, as well as potential others in development.

Circulating microRNAs as biomarkers for the early diagnosis of childhood tuberculosis infection.

MicroRNAs (miRNAs) are a class of highly conserved, single-stranded RNA molecules (length, 18–25 nt) that regulate the expression of their target mRNAs. Previous studies have demonstrated that miRNAs may be novel biomarkers in the diagnosis of certain diseases. In order to evaluate the diagnostic value of miRNAs in childhood tuberculosis (TB), the circulating miRNA profile was determined using microarray analysis. An miRNA-gene network was constructed to identify closely associated miRNAs and these miRNAs were validated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). A receiver operational curve (ROC) was used to evaluate the diagnostic sensitivity and specificity of confirmed miRNAs. The microarray data demonstrated that 29 miRNAs were altered with 15 upregulated and 14 downregulated. The network showed indicated 14 miRNAs that are critical in childhood TB. RT-qPCR validated that miR-1, miR-155, miR-31, miR-146a, miR-10a, miR-125b and miR-150 were downregulated in while miR-29 was upregulated in children with TB compared with uninfected children. The ROC curve data indicated the diagnostic value of single miRNA was as follows: miR-150>miR-146a>miR-125b>miR-31>miR-10a>miR-1>miR-155>miR-29. Notably, a combination of these miRNAs exhibited increased diagnostic value compared with any single miRNA. To the best of our knowledge, the present study is the first to identify the expression profile of circulating miRNAs in childhood TB and demonstrated that miRNAs may be a novel, non-invasive and effective biomarker for the early diagnosis of childhood TB.

Recent advances in the diagnosis and treatment of childhood tuberculosis.

Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as underdiagnosed pediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge.

Classic and New Diagnostic Approaches to Childhood Tuberculosis

Tuberculosis in childhood differs from the adult clinical form and even has been suggested that it is a different disease due to its differential signs. However, prevention, diagnostics, and therapeutic efforts have been biased toward adult clinical care. Sensibility and specificity of new diagnostic approaches as GeneXpert, electronic nose (E-nose), infrared spectroscopy, accelerated mycobacterial growth induced by magnetism, and flow lateral devices in children populations are needed. Adequate and timely assessment of tuberculosis infection in childhood could diminish epidemiological burden because underdiagnosed pediatric patients can evolve to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem.

SPOROTRICHOID-LIKE TUBERCULOSIS

Cutaneous tuberculosis (TB) is a rare presentation of tuberculosis infection in childhood, especially in developed countries. The commonest forms of cutaneous TB, in declining order, are scrofuloderma, lupus vulgaris, lichen scrofulosorum, and TB verrucosa cutis. We described 2 cases of sporotrichoid-like cutaneous tuberculosis infection, 1 localized to a limb and regional nodes and 1 associated with disseminated disease.

Childhood tuberculosis infection and disease: a spatial and temporal transmission analysis in a South African township.

Tuberculosis (TB) remains a leading cause of mortality and morbidity in South Africa. While adult TB results from both recent and past infection, childhood TB results from recent infection and reflects ongoing transmission despite current TB control strategies. A South African community with high rates of TB and HIV disease. A Geographic Information System was used to spatially and temporally define the relationships between TB exposure, infection and disease in children < 15 years of age with exposure to adult HIV-positive and HIV-negative TB disease on residential plots between 1997 and 2007. During the study period the annual adult TB notification rate increased from 629 to 2 106/100 000 and the rate in children aged < 15 years ranged between 664/100 000 and 1 044/100 000. The mean number of exposures to adult TB for TB-uninfected children, latently TB-infected children and TB cases were 5.1%, 5.4% and 33% per annum and the mean number of adult smear-positive cases per exposed child was 1.0, 1.6 and 1.9, respectively. Acquisition of TB infection was not associated with HIV status of the adult TB case to which the child was exposed, and 36% of child TB cases were diagnosed before the temporally closest adult case on their plot. Childhood infection and disease were quantitatively linked to infectious adult TB prevalence in an immediate social network. Childhood infection should be monitored in high-burden settings as a marker of ongoing TB transmission. Improved knowledge of township childhood and adult social networks could also facilitate targeted active case finding, which may provide an adjunct to currently failing TB control strategies.

T cell-based diagnosis of childhood tuberculosis infection

T-cell interferon-gamma release assays (TIGRAs), available as enzyme-linked immunospot (ELISpot) and enzyme-linked immunoassay (ELISA), potentially significantly advance on the tuberculin skin test (TST) for diagnosis of tuberculosis infection. We review all publications using TIGRAs in children to appraise paediatricians of the advantages and limitations of these new blood tests. Unlike TST, both tests are independent of Bacille Calmette-Guérin vaccination status, providing higher diagnostic specificity. In children with active tuberculosis ELISpot is more sensitive than TST and is unaffected by HIV infection, age under 3 years or malnutrition; ELISA data are currently limited. In the absence of a gold-standard test for latent tuberculosis infection, tuberculosis exposure was used as a surrogate marker; ELISpot generally correlates better with tuberculosis exposure than TST, while ELISA correlates broadly similarly. Indeterminate test results in young children are rare with ELISpot and are more common with ELISA. Although longitudinal studies quantifying risk of progression to tuberculosis in tuberculosis-exposed children with positive TIGRA results are required urgently, the small but rapidly expanding evidence-base since the first application of TIGRAs to childhood tuberculosis in 2003 combined with recent national guidelines makes a strong case for judicious use of TIGRAs in clinical management of paediatric tuberculosis.

T-Cell–Based Diagnosis of Neonatal Multidrug-Resistant Latent Tuberculosis Infection

Young children exposed to tuberculosis have a high risk of progression to severe tuberculosis disease, but diagnosis of recent infection is hindered by the poor sensitivity of the tuberculin skin test. Whether new blood tests can detect latent infection in this vulnerable group is unknown because there is no gold standard. We monitored a tuberculin skin test-negative infant whose mother had infectious multidrug-resistant tuberculosis with enzyme-linked immunospot, a blood test that enumerates Mycobacterium tuberculosis-specific T cells. The enzyme-linked immunospot test became persistently positive by 6 months, and 18 months later the child developed active tuberculosis despite appropriate chemoprophylaxis. At this point, the magnitude of the enzyme-linked immunospot response increased >10-fold. Our findings demonstrate that this blood test detected latent infection with dormant, yet viable, bacilli and illustrate how enzyme-linked immunospot could improve diagnosis of childhood tuberculosis infection.

Highlights of twentieth century surgery in Hungary.

On a cold winter morning, in November 1914 a Russian officer was running through the barracks of the camp of the AustrianHungarian prisoners of war in Siberia. He was desperately looking for a prisoner, a Hungarian physician-officer, otologist Robert Barany. At last he found the doctor and handed him a telegram that had just arrived from Sweden. Dr. Barany opened the telegram and saw that it contained the announcement that he was awarded the Nobel Prize. Prince Charles of Sweden, President of the Swedish Red Cross Organization, contacted Prince Konstantin of Russia, President of the Russian Academy of Sciences, asking for his help to release Dr. Barany, but the attempt was unsuccessful. However, Dr. Barany was transported from the camp to a hospital in Kazan. Doctor Barany had suffered from a childhood tuberculosis infection in one of his legs, and as a consequence his walk was imperfect the rest of his life. Here, in Kazan, the Russian army doctor, a general, while examining his Hungarian colleague noted this minor alteration. “Ah, you are wounded,” he said. Dr. Barany protested: “I am not wounded.” The Russian officer refused to accept the remark, telling his patient: “To determine who is wounded and who is not, that’s my job and not yours!” Hence Dr. Barany was released as a war-disabled ex-serviceman, and in September 1916 he was able to attend the Nobel Prize ceremony in Sweden. This true story reflects how much Hungarian life and science were affected by the politics of the twentieth century. Hungary, situated in the eastern part of central Europe is 93,000 km after being reduced to a third of its former territory as a result of the Treaty of Trianon, which put an end to World War I. There are 15 million Hungarians living around the world, 5 million of them outside Hungary. The Magyars arrived in the Carpathian Basin in 896 AD. During the years 2000 and 2001 we celebrated not only the turn of a new millennium but also the 1000th anniversary of the coronation of our first King, St. Stephen, who laid the foundations of Hungarian statehood and the acceptance of Christianity in Hungary. The medical profession has been honored and appreciated even from the earliest times in the history of the nation. On the Hungarian royal crown (called the “Holy Crown”) one can find the portraits of the famous twin brothers who were respected physicians during the Middle Ages, the martyrs St. Cosmas and St. Damian. To evaluate Hungarian surgery during the twentieth century we must go back to previous times.

Mycobacterium tuberculosis infection and the subsequent development of asthma and allergic conditions

Background: Epidemiologic studies have suggested that certain viral infections, as well as exposure to Mycobacterium tuberculosis in early life, could, at least to some extent, prevent the subsequent development of atopic disease. Objective: We investigated whether M tuberculosis infection in childhood or adolescence has any effect on the development of asthma and allergic conditions in later life. Methods: The study subjects (n = 1162) were individuals notified to the National Tuberculosis Registry between January 1, 1966, and December 31, 1969, who were 20 years of age or younger and had verified or justifiably probable new active tuberculosis of respiratory or other organs. The control subjects were age-matched, sex-matched, and geographically matched control pairs from the Population Registry of the Social Insurance Institution in Finland. The subjects were followed for 28 to 32 years. The prevalence of persistent asthma and allergic conditions among men and women at the end of 1997 were calculated on the basis of the Drug Reimbursement Registry of the Social Insurance Institution in the whole study population and in the subgroup of subjects aged 16 years or younger at the time of M tuberculosis infection. Results: In women a significantly lower prevalence of persistent asthma was found among those aged 16 years or younger at the time of M tuberculosis infection than among the control subjects (3.7% vs 8.3%, respectively; P = .035). The women with a history of tuberculosis also showed a significantly lower prevalence of allergic conditions than the control subjects (8.3% vs 14.0%, respectively; P = .003) when the whole study population of women was considered. In men, however, the only significant difference between the cases and control subjects was found for persistent asthma, with the cases showing a significantly higher prevalence than the control subjects (4.4% and 1.8%, respectively; P = .008). Conclusion: M tuberculosis infection in childhood significantly reduced the occurrence of subsequent asthma in women. Moreover, this infection was also found to reduce the occurrence of allergic conditions in later life in women. By contrast, no suppressive effect of M tuberculosis infection in childhood or adolescence on the later development of asthma or allergic conditions could be observed in men. The differences in the natural history of atopic disease between the sexes and the occurrence of tuberculosis mostly in later childhood and adolescence may largely explain our findings. (J Allergy Clin Immunol 1999;1211-4.)

Miliary tuberculosis in children: a clinical review.

Miliary tuberculosis infection in childhood remains a significant health problem in developing countries. To characterize the clinical features of the disease, symptoms, signs and laboratory findings, associated infections and outcomes of the 23 children (14M, 9F) with miliary tuberculosis admitted to the Dicle University Hospital, Diyarbakir, Turkey from 1990 to 1997 were analysed. Mean age of the patients was 3.7 y ranging between 6 months and 11 y. All but 3 patients were below 6 y of age, and 5 of the patients were under 1 y of age. All of the children had not received BCG vaccination except for 1 who was immunized after the age of 5 y. Only 6 children had a positive reaction to 5 TU tuberculin test at admission to hospital. Eight of the 23 subjects were infected in the family, and all were nonHIV infected cases. All of the children were diagnosed clinically and by a miliary infiltrate visible on chest roentgenogram. Five cases had positive culture results for Mycobacterium tuberculosis. Duration of onset of symptoms prior to admission ranged between 15 d and 8 months with a mean of 58 d. The most frequently seen symptoms and clinical findings were fever in 17 cases, rales in 14, loss of appetite and weight in 10 and hepatosplenomegaly in 9 cases. Two cases had prior measles infection and 1 of the patients presented facial paralysis. Seven cases had also tuberculous meningitis. The outcome in general was good, with mortality in 2 cases.

The New Conception of Tuberculosis Infection

SO much has been written regarding the many and varied aspects of tuberculosis, that it is not likely that anything particularly new can be said about the disease, yet from the great volume of research in recent years, we are discovering newer viewpoints, even of old beliefs about it, and it is of the utmost importance that from time to time we review these changing viewpoints, if we are to make the most of our responsibilities and opportunities for the prevention and cure of the Great White Plague. In no instance is this more true than in the whole problem of tuberculosis infection, particularly as it relates to childhood. So important are these newer conceptions of infection in childhood, and the methods of prevention of subsequent disease, that until our conception of tuberculosis infection shall have radically changed and come more into line with the newer teachings of scientific medical research, a large part of our efforts in the tuberculosis campaign will be misdirected and wasted. It is, therefore, the purpose of the writer to discuss our newer knowledge with reference to tuberculosis infection in childhood; the clinical aspects of tuberculous disease in childhood; and a program for the recognition and treatment of childhood tuberculosis.