Challenges and controversies in childhood tuberculosis

Reuter, Anja; Hughes, Jennifer; Furin, Jennifer

doi:10.1016/s0140-6736(19)32045-8

Cited by 61 publications

(47 citation statements)

References 99 publications

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“…Tuberculosis is among the top 10 causes of childhood mortality worldwide with a global estimate of 130,000 pediatric deaths per year 27 . Lack of appropriate screening, diagnostic, and treatment protocols has a severe toll on the life of TB pediatric patients: it is estimated that 1 in 4 undiagnosed children will die of the disease 19 .…”

Section: Discussionmentioning

confidence: 99%

Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes

Magni

Rruga

Alsaab

et al. 2020

Sci Rep

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An accurate urine test for diverse populations with active tuberculosis could be transformative for preventing TB deaths. Urinary liporabinomannan (LAM) testing has been previously restricted to HIV co-infected TB patients. In this study we evaluate urinary LAM in HIV negative, pediatric and adult, pulmonary and extrapulmonary tuberculosis patients. We measured 430 microbiologically confirmed pretreatment tuberculosis patients and controls from Peru, Guinea Bissau, Venezuela, Uganda and the United States using three monoclonal antibodies, MoAb1, CS35, and A194, which recognize distinct LAM epitopes, a one-sided immunoassay, and blinded cohorts. We evaluated sources of assay variability and comorbidities (HIV and diabetes). All antibodies successfully discriminated TB positive from TB negative patients. ROAUC from the average of three antibodies' responses was 0.90; 95% CI 0.87-0.93, 90% sensitivity, 73.5% specificity (80 pg/mL). MoAb1, recognizing the 5-methylthio-dxylofuranose(MTX)-mannose(Man) cap epitope, performed the best, was less influenced by glycosuria and identified culture positive pediatric (N = 19) and extrapulmonary (N = 24) patients with high accuracy (ROAUC 0.

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Section: Discussionmentioning

confidence: 99%

Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes

Magni

Rruga

Alsaab

et al. 2020

Sci Rep

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“…Childhood exposure might only be treated with 6 to 9 months of daily isoniazid, four months of daily rifampicin, or three months of daily isoniazid and rifampicin, regardless of drug costs and adverse events in different country settings, where TB prevalence plays a determinant role in defining optimal prevention strategies. 99 Drug safety and effectiveness in children also represent an information gap regarding the diversity of adult regimes for drug-sensitive and drugresistant TB. Diverse clinical forms in childhood TB enhance the treatment choice dilemma, suggesting that patients with isolated lymph node or pulmonary disease might require only a short treatment with few drugs; meanwhile, complicated or severe TB clinical forms might need a more prolonged therapy with more drugs.…”

Section: The Impact Of Immune Status On Treatment Regimensmentioning

confidence: 99%

“…Diverse clinical forms in childhood TB enhance the treatment choice dilemma, suggesting that patients with isolated lymph node or pulmonary disease might require only a short treatment with few drugs; meanwhile, complicated or severe TB clinical forms might need a more prolonged therapy with more drugs. [99][100][101] Preclinical models of each type of TB presentation, supported by new diagnostic tools, such as mass spectrometry, dynamic positron emission tomography bioimaging, and pharmacokinetic modeling, will give access to remarkable information for clinical trials design and development, solving the divergences in clinical decision making. 102 Current guidelines for the management of TB in children contemplate regimes adjusted to sex, age, weight, and drug-sensitivity.…”

Section: The Impact Of Immune Status On Treatment Regimensmentioning

confidence: 99%

“…113 The treatment issues are usually focused on drug availability, lack of pediatric formulations, and trouble with patients' follow up and adherence to treatment. 99,103,114 Infection and Drug More clinical trials are needed to comprehend the extent of the effect of these therapies. Displaying the individual response to treatment, according to genetic, immunological, or environmental factors, would be valuable information for clinicians in order to consider drug changes, treatment duration, or the use of adjunct therapies.…”

Section: The Impact Of Immune Status On Treatment Regimensmentioning

confidence: 99%

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Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis

Gutiérrez‐González

Juárez

Carranza

et al. 2021

IDR

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The diagnosis of tuberculosis (TB) in children is difficult because of the low sensitivity and specificity of traditional microbiology techniques in this age group. Whereas in adults the culture of Mycobacterium tuberculosis (M. tuberculosis) , the gold standard test, detects 80% of positive cases, it only detects around 30–40% of cases in children. The new methods based on the immune response to M. tuberculosis infection could be affected by many factors. It is necessary to evaluate the medical record, clinical features, presence of drug-resistant M. tuberculosis strains, comorbidities, and BCG vaccination history for the diagnosis in children. There is no ideal biomarker for all TB cases in children. A new strategy based on personalized diagnosis could be used to evaluate specific molecules produced by the host immune response and make therapeutic decisions in each child, thereby changing standard immunological signatures to personalized signatures in TB. In this way, immune diagnosis, prognosis, and the use of potential immunomodulators as adjunct TB treatments will meet personalized treatment.

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“…6,55,64 The areas of controversies include among others; duration of treatment and regimen, secondary preventive therapy, fear for inducing drug resistance, inclusion or exclusion of other age groups and screening procedures. 65,66 Also, children who are contacts of DR-TB have high risk of contracting DR-TB, therefore should be screened and given preventive therapy in form of fluoroquinolone with or without another effective drug for prevention, [66][67] although some authors argue that such recommendation is early for now. 68 Despite the WHO recommendations for the preventive therapy, a rather low up-take of the treatment and sometimes poor adherence to the recommendation of the treatment by care givers and physiciansrespectively were reported from many studies.…”

Section: Diagnosis Of Tb In Childrenmentioning

confidence: 99%

Childhood tuberculosis: Characteristics and peculiarities

Mustapha¹,

Ashir²,

Rabasa³

et al. 2020

Nig. J. Paed.

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Tuberculosis (TB) is an important infectious disease of public health concern. The effects of TB on children in terms of morbidity and mortality is more than that of adults. These may not be unconnected with the differences in characteristics and peculiarities of the disease in children. Tuberculosis in children is usually primary, paucibacillary, characterized by difficulties in diagnosis of both drug susceptible and resistant TB associated with poor uptake of preventive therapy for those with latent infection, contacts and people living with HIV and AIDS (PLWHA) in most developing countries.While significant similarities exist between spectrum of TB occurring in adults and children, the characteristics and peculiarities of childhood TB may be unknown to policy makers and some clinicians, hence giving it less focus in control measures. The aim of this review is to highlight some of the characteristics and peculiarities of TB in children using PubMed/PubMed Central (PMC) and MEDLINE databases searched for relevant search strings from December, 2018 to September, 2019. Appropriate hard copies of books and journal articles were also included. Conclusion: While the management of TB in children is characterized by difficulties due to both peculiarities of children and the disease; with detailed clinical assessment and examination of necessary specimen in addition to strict adherence to the guidelines of the national TB control program, more cases of TB in children can be prevented, diagnosed, treated and reported.

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Challenges and controversies in childhood tuberculosis

Cited by 61 publications

References 99 publications

Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes

Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes

Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis

Childhood tuberculosis: Characteristics and peculiarities

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