Bacillus Calmette–Guérin is a preventive factor in mortality of childhood tuberculous meningitis

Kelekçi, Selvi; Karabel, Müsemma; Karabel, Duran; Hamidi, Cihat; Hoşoğlu, Salih; Gürkan, Mehmet Fuat; Taş, Mehmet

doi:10.1016/j.ijid.2013.10.001

Cited by 15 publications

(16 citation statements)

References 14 publications

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“…[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] A recent meta-analysis of the efficacy of BCG vaccine against the pulmonary, meningeal and disseminated forms of TB included 21 randomized or quasi-randomized clinical trials: 18 involving patients with pulmonary TB, and 6 involving patients with meningeal and/or military forms. 30 The panel marginally supports a recommendation for use subjects vaccinated at birth (RR 0.41, 95% CI 0,29-0.58).…”

Section: What Is the Current Role Of Bcg Vaccination?mentioning

confidence: 99%

“…20 Kelekçi et al analyzed 172 cases of TBM in a Turkish university hospital, and found that BCG vaccine significantly protected against death due to the disease (p D 0.05). 21 Gaensbauer et al carried out a cohort study of nursery school children exposed to teachers with infectious TB and found that the BCG vaccine had a protective effect against the disease, and that 11.3 subjects needed to be vaccinated to prevent one case of active disease. 22 However, this study did not consider the possible additional risks for TB in the vaccinated subjects, such as coming from a country in which TB is endemic.…”

Section: What Is the Current Role Of Bcg Vaccination?mentioning

confidence: 99%

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Recommendations for pediatric tuberculosis vaccination in Italy

Montagnani

Esposito

Galli

et al. 2015

Human Vaccines & Immunotherapeutics

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Bacillus Calmette-Guerin (BCG) vaccine is still the only vaccine approved for the prevention of tuberculosis (TB), and is widely used in highly endemic countries, where all newborns receive a single intradermal dose immediately after birth; however, the recommendations concerning its use in Europe vary widely from country to country. This document describes the recommendations of a group of Italian scientific societies concerning its pediatric use in Italy, the persistence of the protection it provides, its safety, its interference with tuberculin skin test (TST) responses, and the children who should be vaccinated. The experts conclude that BCG vaccination provides a good level of protection against tuberculous meningitis and disseminated forms, and a fair level of protection against pulmonary disease; the protective effective lasts at least 10 years, and revaccination offers no advantages over a single administration. The vaccine is safe in immunocompetent subjects, and affects the response to a TST for at least 6 y On the basis of these observations, we recommend its use in Italy in all TST-negative immunocompetent newborns and breastfeeding infants aged <6 months, and all TST-negative children aged between 6 months and 5 y who come from highly epidemic areas, or whose parents come from highly endemic areas, or who have been in contact with a family member with active TB without contracting the disease themselves.

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Section: What Is the Current Role Of Bcg Vaccination?mentioning

confidence: 99%

Section: What Is the Current Role Of Bcg Vaccination?mentioning

confidence: 99%

Recommendations for pediatric tuberculosis vaccination in Italy

Montagnani

Esposito

Galli

et al. 2015

Human Vaccines & Immunotherapeutics

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“…Ha sido reportado que la vacuna de la BCG podría reducir el riesgo de MEC TBC hasta un 75 a 86% (3), pero no por completo (22). En esta serie la recibieron el 67,7% de los niños comparado con el 60% en 1993, incluso 3 de los 4 lactantes menores de 1 año recibieron la vacuna de la BCG, lo contrario a lo descrito en el estudio de 1993, donde la mayoría de lactantes no lo recibieron, observación débil por el pequeño número de casos de nuestro estudio, otros factores son importantes, como la edad que recibió la vacuna BCG, la desnutrición o inmunodeficiencias asociadas.…”

Section: Rev Neuropsiquiatr 78 (1) 2015unclassified

“…De los pacientes con hidrocefalia, que es la complicación más común de la MEC TBC (31), menos del 40% necesitaron drenaje ventricular, menor porcentaje que otras publicaciones (3,27,22,24,32).…”

Section: Rev Neuropsiquiatr 78 (1) 2015unclassified

Meningoencefalitis tuberculosa en niños. Experiencia en el Instituto Nacional de Salud del Niño de Lima, 2009 – 2013

et al. 2015

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Se seleccionaron 31 casos con diagnóstico de MEC TBC, con una frecuencia de 7,4 casos por año, edad promedio de 7,3 años, la relación varón/ mujer fue 1,2. Los características más frecuentes fueron la desnutrición, el contacto TBC y la TBC pulmonar. Los síntomas más frecuentes fueron la fiebre, vómitos, y somnolencia. El trastorno de la conciencia y el síndrome meníngeo fueron los síndromes neurológicos más comunes. La mayoría ingresaron en estadio II (83,9 %) y egresaron con secuelas mayores (51,6%). Los hallazgos en el líquido cefalorraquídeo (LCR) fueron pleocitosis promedio de 275,6 células /mm3 y mediana de 184 células/ mm3 (rango entre 15-1364 células/mm3), el Bacilo de Koch fue aislado por cultivo en el 19,5% de los casos. Los hallazgos más frecuentes de neuroimagen fueron la hidrocefalia (58%), infarto ygranuloma. Seis pacientes con hidrocefaliarequirieron derivación ventricular. Cinco de los pacientes desarrollaron reacción paradójica. La letalidad fue 12,9%.Conclusiones: La incidencia hospitalaria de MEC TBC fue 7,4 casos por año, la mayoría ingresó en estadio IIy egresó con secuelas mayores, en la neuro imagen la hidrocefalia fue el hallazgo más observado, la letalidad fue 12,9%.PALABRAS CLAVE: Meningoencefalitis, meningitis, tuberculosis, niños, TBC. SUMMARY Objectives:To describe clinical, epidemiological, laboratory andneuro imaging characteristics of children with Meningeal Tuberculosis (MEC TBC) at the Instituto Nacional de Salud del Niño, in Lima, Peru. Methods: Retrospective, descriptive case series from January 2009 to September 2013. Results: 31 cases with MEC TBC were included, with a frequency of 7.4 cases per year. The average age was7.3 yearsand boy/girl rate was 1.2. The more frequent characteristics were the malnutrition, a positive TBC contact and pulmonary TBC. The most common clinical findings were fever, vomits, altered consciousness and meningealsigns. Most cases were in the II clinical

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“…TBM is a central nervous system infection caused by Mycobacterium tuberculosis (M.tb) and it is the most severe form of tuberculosis, with high morbidity and mortality (4,5). The rate of TBM is higher among children than adults (7). A study in South Africa reported that TBM is the most common form of bacterial meningitis among children (8).…”

Section: Introductionmentioning

confidence: 99%

Potential of host serum protein biosignatures in the diagnosis of tuberculous meningitis in children

Manyelo

Solomons

Snyders

et al. 2019

Preprint

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Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis and results in high morbidity and mortality in children. Diagnostic delay contributes to the poor outcome. There is an urgent need for new tools for the rapid diagnosis of TBM, especially in children. Methods:We collected serum samples from children in whom TBM was suspected at a tertiary hospital in Cape Town, South Africa. Children were subsequently classified as having TBM or no TBM using a published uniform research case-definition. Using a multiplex cytokine array platform, we investigated the concentrations of serum biomarkers comprising 7-markers that were previously found to be of value in the diagnosis of adult pulmonary TB (CRP, SAA, CFH, IFN-γ, IP-10, Apo-AI and transthyretin) plus other potentially useful host biomarkers as diagnostic candidates for TBM. Findings:Of 47 children included in the study, 23 (48.9%) had a final diagnosis of TBM of which six had HIV co-infection. A modified version of the adult 7-marker biosignature in which transthyretin was replaced by NCAM1, diagnosed TBM in children with AUC of 0.80 (95% CI, 0.67-0.92), sensitivity of 73.9% (95% CI, 51.6-89.8%) and specificity of 66.7% (95% CI, 44.7-84.4%). A new childhood TBM specific 3-marker biosignature (adipsin, Aβ42 and IL-10) showed potential in the diagnosis of TBM, with AUC of 0.84 (95% CI, 0.73-0.96), sensitivity of 82.6% (95 CI, 61.2-95.0%) and specificity of 75.0% (95% CI, 53.3-90.2%) after leave-one-out cross validation.Conclusion: An adult 7-marker serum protein biosignature showed potential in the diagnosis of TBM in children. However, a smaller childhood TBM-specific biosignature demonstrated improved performance characteristics. Our data indicates that bloodbased biomarkers may be useful in the diagnosis of childhood TBM and require further investigation.

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Bacillus Calmette–Guérin is a preventive factor in mortality of childhood tuberculous meningitis

Abstract: BCG vaccination is effective in the prevention of TBM-associated mortality in childhood. TST negativity may be a sign of a poor prognosis in TBM cases.

Cited by 15 publications

References 14 publications

Recommendations for pediatric tuberculosis vaccination in Italy

Recommendations for pediatric tuberculosis vaccination in Italy

Meningoencefalitis tuberculosa en niños. Experiencia en el Instituto Nacional de Salud del Niño de Lima, 2009 – 2013

Potential of host serum protein biosignatures in the diagnosis of tuberculous meningitis in children

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