Features of Adolescents Tuberculosis at a Referral Tb's Hospital in Tehran, Iran

Lotfian, Ferial; Bolursaz, Mohammad Reza; Khalilzadeh, Soheila; Baghaie, Noshin; Hassanzad, Maryam; Velayati, Ali Akbar

doi:10.4084/mjhid.2016.005

Cited by 12 publications

(15 citation statements)

References 27 publications

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“…Table 1 shows the major sites of disease and prevalence of confirmed disease in case series of adolescents with tuberculosis identified during this review. 10-12, [14][15][16][17][18][19][20][21][22][23][24] While peripheral (most commonly cervical) lymphadenopathy is often reported as the next most common site of disease in adults, it has infrequently been reported in adolescents. Up to 4% of adolescents in two series had tuberculous meningitis, 11,16 although this may be explained by selection bias resulting from those with more severe forms of tuberculosis being more likely to be identified and correctly diagnosed.…”

Section: Figurementioning

confidence: 99%

“…26 Adolescents with pulmonary tuberculosis commonly have "bacteriologically confirmed" disease (i.e. smear, culture or PCR positive), [9][10][11]16,19,26 although paucibacillary disease remains common and negative test results do not rule out tuberculosis. Yields from multiple samples (usually two) collected on the same day have been shown to be similar to samples collected on separate days in children, potentially making sample collection less burdensome and more feasible.…”

Section: Figurementioning

confidence: 99%

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Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

116

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Adolescence is characterised by a dramatic increase in the incidence of tuberculosis, a fact that has been appreciated since the early 20 th century. The majority of the world's adolescents live in low and middle-income countries where tuberculosis remains common, and where they comprise one quarter of the population. Despite this, adolescents have not yet been addressed as a distinct population in tuberculosis policy or within tuberculosis treatment services, and emerging evidence suggests that current models of care do not meet their needs.This article reviews current knowledge about tuberculosis in adolescence with a focus on the management of infection and disease, including HIV co-infection and rifampicin-resistant tuberculosis. Recent progress in vaccine development is outlined and important directions for future research are highlighted. Search strategy and selection criteriaThis was a narrative review of the literature on adolescent tuberculosis, informed by expert opinion and clinical experience. We reviewed the English-and Spanish-language literature for studies on adolescent tuberculosis to identify case series documenting clinical presentation and treatment outcomes. We searched PubMed with the following string on 19August 2019: ('tuberculosis'[Title]) AND ('adolescent'[TIAB]). The search returned 210 results, of which 11 were eligible for inclusion (Table 1), and we identified three additional studies from reference lists, for a total of 14 studies. Studies reporting solely on prevalence or where data from adolescents was aggregated with those of younger children or adults were excluded. Data were extracted regarding major site(s) of disease, percent of adolescents with microbiologic confirmation, adverse drug reactions, and final treatment outcomes.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Adolescent tuberculosis

Snow

Cruz

Seddon

et al. 2020

The Lancet Child & Adolescent Health

116

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“…The most commonly reported symptoms were coughing (55.9%), fever (46.9%), and weight loss (37.9%), which were also described as the main symptoms in similar cohorts. 12 , 13 , 14 The occurrence of these symptoms were correlated with age: they were more present in the group of children over 10 years of age. The low frequency of these symptoms in the patients younger than 10 years of age and the oligosymptomatic nature of TB in this age group reinforce the difficulty of diagnosing the disease in younger children.…”

Section: Discussionmentioning

confidence: 97%

Tuberculose Em Pacientes Pediátricos: Como Tem Sido Feito O Diagnóstico?

Cano

Romaneli

Pereira

et al. 2017

Rev. paul. pediatr.

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Objective: To describe clinical, radiological, epidemiological, and microbiological characteristics of pediatric patients with diagnosis of tuberculosis in a period of 15 years.Methods: Retrospective study including children and adolescents younger than 18 years diagnosed with tuberculosis in the Clinical Hospital of the Universidade Estadual de Campinas in São Paulo State, Brazil. Active tuberculosis was defined by the identification of Mycobacterium tuberculosis in culture, microscopy, or histopathological examination. Children with positive clinical history and radiological tests who had been exposed to sick adults or with positive tuberculin skin test were also considered as having active tuberculosis. Statistical analysis compared the data obtained from children younger and older than 10 years of age, since they present a disease pattern more similar to adults.Results: There were 145 identified cases, 61.4% in patients under 10 years of age. The main symptoms reported were coughing (55.9%) and fever (46.9%), and the variables of fever, coughing, weight-loss, and pain were significantly influenced by age, with a higher frequency in older children. Diagnosis was confirmed by culture, microscopy, or histopathology in 67.6% of the cases. The other cases (32.4%) had the diagnosis of tuberculosis based on clinical, radiological, and epidemiological characteristics, as well as tuberculin skin test. The positivity for culture, microscopy, and tuberculin skin test was, respectively, 65.8, 35.7, and 72.3%. History of contact with a sick adult was confirmed in 37.2%, without influence of age.Conclusions: Diagnosis of tuberculosis in children is still a challenge, since all the confirmation tests have low positivity. These results demonstrate the need for new diagnostic methods and improved strategies for searching sick contacts.

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“…Similar to our study, Lotfian et al reported on outcomes of adolescent TB patients in Iran and did not find differences in loss- to-follow-up between younger and older adolescents. However the small sample size of that study precluded investigators from performing the statistical modelling required to identify independent risk factors for loss-to-follow up [26]. In addition, a study in India found no loss to follow-up in their sample of young people in TB care, but here too the small sample size of the study, in comparison to the large adolescent population at risk of TB disease in that country, means the findings are unlikely to be generalizable[27].…”

Section: Discussionmentioning

confidence: 99%

HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town

et al. 2019

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TB remains a leading cause of mortality and morbidity in sub-Saharan Africa, due to the HIV epidemic. As TB treatment is lengthy, the completion of the full course of treatment may be especially challenging for young people. We therefore aimed to identify the extent of and reasons underlying loss to follow-up from TB treatment among young people in Cape Town. Accordingly, we reviewed the outcomes of young people treated for TB in Cape Town during 2009–2013, across three age groups: younger adolescents (10–14 years); older adolescents; (15–19 years) and young adults (20–24 years). We employed logistic regression analysis to identify risk factors for loss from TB care. 23,737 patients aged 10–24 were treated for drug sensitive TB over the study period. Of these, the HIV co-infection prevalence was 18.5% for younger adolescents, 12.9% for older adolescents and 33.1% for young adults. From age 16, HIV prevalence increased disproportionately among young women: by age 22, over 50% of women were TB/HIV co-infected compared to 14% of men. TB treatment success (cure plus completion) was 84.4%, while 1.7% of patients died, 9.5% were lost-to follow-up and 0.4% failed treatment. Being an older adolescent (aOR 1.75 [95% CI: 1.38–2.21]) or young adult (aOR: 1.96 [95% CI: 1.57–2.45]) increased the risk of loss-to-follow up, relative to being a younger adolescent. Further risk factors for loss from TB care were male gender (aOR: 1.33 [95% CI:1.20–1.46]), being a TB/HIV co-infected young person (aOR 1.74 [95% CI: 1.57–1.93]) and having had prior treatment for TB (aOR 3.17 [95% CI 2.87–3.51]). We identified risk factors for loss to follow-up and highlighted the need to focus on HIV prevention and retention in TB care among young people. TB care tailored to the needs of young people could improve patient retention, similar to improved outcomes reported by youth friendly HIV clinics.

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Features of Adolescents Tuberculosis at a Referral Tb's Hospital in Tehran, Iran

Cited by 12 publications

References 27 publications

Adolescent tuberculosis

Adolescent tuberculosis

Tuberculose Em Pacientes Pediátricos: Como Tem Sido Feito O Diagnóstico?

HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town

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