Childhood Tuberculosis in Household Contacts of Newly Diagnosed TB Patients

Abstract

IntroductionChildhood tuberculosis (TB), although estimated to account for a major proportion of the global TB disease burden, has a lower public health priority. Reliable research and surveillance data on childhood TB is limited in most regions of the world. This study was conducted to assess the burden of childhood TB among the household contacts of new TB patients in Karachi, Pakistan.MethodsA retrospective analysis of children (<15 years) who were household contacts of new adult TB patients presenting to Marie Adelaide Leprosy Center (MALC) clinics in Karachi during the period of 2008 to 2010 was conducted.ResultsOf the household children contacts (n = 6613) screened, 317 were suspected and 121(1.8%) diagnosed with TB. These included 89 (73.6%) with pulmonary and 32 (26.4%) with extra-pulmonary disease. Smear positivity rate in pulmonary cases was 32.6%. Mean age of children diagnosed with TB was 11.7 (±2.8) years. Within the child-contacts screened, disease was found to be significantly higher among females (2.3%) in comparison to males (1.2%) (p-value <0.01). The commonest relationship of source cases to diagnosed children was the mother (n = 51, 42.1%). The source case was a female for 66.1% (n = 76) of the children.ConclusionA smear positivity rate of 32.6% amongst pulmonary cases suggests their potential to spread disease and emphasizes a need to review the contribution of children in transmission of TB within communities. Greater vulnerability of the female child and considerable role of mother in disease transmission highlights a need to increase focus on females in TB control programs in Pakistan.

Tuberculosis vaccine with high predicted population coverage and compatibility with modern diagnostics

“…We therefore used in silico epitope-binding predictions to estimate the population coverage of the H65 vaccine and the individual protein components in countries with a high burden of TB. Because CD4 + T-cell-mediated immunity is essential to combat M.tb infection and class 2 HLA proteins are responsible for stimulating CD4 + T cells, we examined the class 2 HLA-DRB1 diversity (22).The DRB1 allele was chosen because DR alleles bind the vast majority of known M.tb epitopes (23), and among the DR alleles, the DRB1 surface expression is five times greater than for other DR alleles (24). Finally, epitope prediction programs for DRB1 alleles are more frequently available than for other class 2 HLA alleles.…”

A utilização da noção de vulnerabilidade na produção de conhecimento sobre tuberculose: revisão integrativa

“…In spite of mentioning "vulnerability" as a descriptor, the 15 publications included in this category (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) focused on identifying risk factors and groups for the development of TB, such as employment, income, education, housing conditions, gender, age, race/colour, debilitating diseases of the immune system, population deprived of liberty and healthcare workers.…”

“…Diseases such as diabetes mellitus and cancer were highlighted as risk factors for TB because they reduce the immunological capacity of the organism (7)(8)(9) . Other studies (8)(9)(10)15) focused on groups that are prone to illness, such as children who live with people infected with TB, the elderly hospitalized population deprived of liberty and health professionals.…”

“…Other studies (8)(9)(10)15) focused on groups that are prone to illness, such as children who live with people infected with TB, the elderly hospitalized population deprived of liberty and health professionals. We also identified studies about the association between lifestyles and the process of acquiring TB (23) , about the identification of risk groups and factors for TB and about the indication of specific health interventions to correct and control behaviour and deviating groups (3) .…”

Clinical, Radiological and Inmunological Features in Children with Pulmonary Tuberculosis: A Review

“…Several studies stated that concomitant diseases and risk factors such as malnutrition, vitamin D deficiency or HIV infection, should be considered as they have important diagnostic and pronostic implications [5][6][7][8]. Some studies suggested greater vulnerability of the female child [9].…”