Tuberculosis in children
D.L. Corrigan,James Y. Paton +1 more
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TLDR
Despite advances in diagnosis, treatment and prevention, tuberculosis (TB) remains a major cause of mortality and morbidity worldwide and many of the commercially available preparations are unsuitable for children.Abstract:
Key points Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Children with TB are markers of recent disease transmission, usually from infectious adults. The 1 million cases of TB in children registered each year is likely to be a gross underestimate. The diagnosis is challenging and often presumed rather than confirmed. Symptoms, if present, are nonspecific. TB infection occurs when a previously uninfected child inhales an infected aerosol droplet. At this stage, the child usually shows no symptoms, the infection passes undetected and the primary focus heals. In most cases the infection is controlled by the body9s immune system and the organisms remain dormant. This is called latent TB. TB disease can develop either then or at a later stage when the organism multiplies, overpowering the host defences. At this stage, symptoms develop and there may be radiological or microbiological evidence of disease. "More bugs require more drugs". In TB infection, the organism load is small and therefore drug-resistant mutations are rare: hence simpler drug regimes are effective. In TB disease, the number of organisms is greater, so a combination of ≥3 drugs is required. Increasing resistance worldwide has led to four drugs being recommended as standard in many areas. Poor adherence to drug therapy is the main barrier to cure. Although directly observed therapy (DOTS) and intermittent therapy may improve the outcome, neither is a panacea. Co-operation and other strategies are required. Bacille Calmette-Guerin (BCG) vaccination remains the most widely used preventative strategy. Its efficacy is uncertain and its use needs to be targeted to neonates in high-risk areas who are most likely to benefit. The development of new vaccines against pulmonary TB is an important global challenge. Educational aims To describe the epidemiology and natural history of TB in children, focusing on pulmonary TB. To explore the challenges of diagnosis and provide an up-to-date overview of the methods available. To outline the management and prevention of pulmonary TB in children. Summary Despite advances in diagnosis, treatment and prevention, tuberculosis (TB) remains a major cause of mortality and morbidity worldwide. Diagnosis and treatment in children present a challenge, particularly in the face of growing drug resistance and coexistent disease such as HIV. New diagnostic methods have not yet been fully validated for use in children. No new drugs have become available in the past 30 years and many of the commercially available preparations are unsuitable for children. In 2006, a number of major documents and strategies were launched aimed at improving the care of children with TB, a previously neglected area.read more
Citations
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Recente contribuição da Organização Mundial de Saúde para o controle da tuberculose na infância
TL;DR: The article comments the pioneer and recent publication of the World Health Organization called "Guidance for National Tuberculosis Programmes on the Management of Childhood Tuber tuberculosis in Children", aiming at spreading interesting aspects on the practice of health professionals.
Journal ArticleDOI
Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status.
Cinthia Pedrozo,Clemax Couto Sant'Anna,Maria de Fátima Bazhuni Pombo March,Sheila Cunha Lucena +3 more
TL;DR: In this article, a sistema de pontuacao, preconizado pelo Ministerio da Saude (MS), foi valido for diagnostico de TB pulmonar em criancas e adolescentes, infectadas ou nao pelo HIV.
Efficacy of the scoring system, recommended by the Brazilian National Ministry of Health, for the diagnosis of pulmonary tuberculosis in children and adolescents, regardless of their HIV status* Eficácia do sistema de pontuação, preconizado pelo Ministério da Saúde, para o diagnóstico de tuberculose pulmonar em crianças e adolescentes infectados ou não pelo HIV
TL;DR: The NMH system scores were significantly higher in the TB and TB/HIV groups than in the other two groups, and therefore, this scoring system was valid for the diagnosis of pulmonary TB in this population, regardless of HIV status.
Journal ArticleDOI
pH-dependent adhesion of mycobacteria to surface-modified polymer nanofibers.
TL;DR: A polymer was successfully modified in such a way that it acquired an affinity for M. tuberculosis and enabled the capture of this organism onto the modified polymer nanofibrous surface.
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Bacteriological Evaluation for Diagnosis of Tuberculosis in Children
TL;DR: Gastric lavage smears and cultures have high diagnostic value in TB diagnosis in children and chest CT-scan is recommended for diagnosis of TB in suspected children when other evaluations are recommended.
References
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TL;DR: Current diagnostic tests for tuberculosis based on tuberculin have poor specificity, and both BCG vaccination and exposure to non-tuberculosis mycobacteria produce a response similar to that induced by infection with Mycobacterium tuberculosis.
Journal Article
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Ben J. Marais,Robert P. Gie,H S Schaaf,Anneke C. Hesseling,C C Obihara,J J Starke,Donald A. Enarson,Peter R. Donald,Nulda Beyers +8 more
TL;DR: Deciding which children to treat may be extremely difficult in high-prevalence, low-resource settings, and the concept of relevant disease provides guidance for more effective public health intervention.
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Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study
TL;DR: Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children and is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfected infants and children.
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Childhood pulmonary tuberculosis: old wisdom and new challenges.
TL;DR: It is emphasized that the infrastructure provided by the directly observed therapy, short-course strategy, combined with well-targeted interventions, slightly improved resources, and greatly improved political commitment, may lead to a dramatic reduction in tuberculosis-related morbidity and mortality among children.