How to manage children who have come into contact with patients affected by tuberculosis

Lancella, Laura; Vecchio, Andrea Lo; Chiappini, Elena; Tadolini, Marina; Cirillo, Daniela María; Tortoli, Enrico; Martino, Maurizio de; Guarino, Alfredo; Principi, Nicola; Villani, Alberto; Esposito, Susanna; Galli, Luisa

doi:10.1016/j.jctube.2015.07.002

Cited by 14 publications

(13 citation statements)

References 51 publications

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“…However, caution in the use of IGRAs in children is based on the potentially immature immune system of infants which might not be capable of responding properly to antigenic stimuli ex vivo (15). Current evidence does not support the use of QFT-IT as an alternative to TST; however, different national guidelines recommend IGRAs in addition to TST in screening algorithms for TB infection (3,24,35).…”

Section: Discussionmentioning

confidence: 99%

“…Children were categorized as TB excluded if, after undergoing QFT-IT based on signs and symptoms suggestive of TB, active disease was excluded and another diagnosis was made at the end of investigation and treatment. According to Italian pediatric TB recommendations (24), before admission to school, children in contact with adults with active tuberculosis, children who had recently arrived from an area where TB is endemic, and those undergoing immunosuppressive therapy were referred to the Pediatric Unit and underwent a medical history investigation including BCG vaccination status, clinical assessment, chest X-ray, and immunological and microbiological assays. After exclusion of active TB, children were categorized at the first investigation and after 3 months as having LTBI based on the physician's decision after evaluating QFT-IT and TST results, risk of exposure, BCG status, and origin.…”

Section: Methodsmentioning

confidence: 99%

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Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

et al. 2018

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The use of interferon gamma (IFN-γ) release assays (IGRAs) for the diagnosis of tuberculosis (TB) infection in children is still under debate because of concerns about the immature immune response in children. The aim of this study was to investigate quantitative values of the QuantiFERON-TB Gold In-Tube (QFT-IT) test, a commercially available IGRA, in a large cohort of children screened for TB infection. A retrospective analysis was conducted on samples from 517 children aged 0 to 14 years old at the Pediatric Unit of S. Orsola-Malpighi University Hospital of Bologna (Italy); quantitative responses to QFT-IT stimuli were analyzed according to diagnosis and age. Elevated IFN-γ values in the QFT-IT nil (background) tube were statistically associated with diagnosis of active TB. Quantitative IFN-γ response to -specific antigens (TB Ag) was not significantly different in children with active TB compared to those with latent TB infection (LTBI), even though the median values were higher in the first group. When children were grouped by age, those less than 5 years old produced significantly higher levels of IFN-γ in response to TB Ag if they had active TB (median 10 IU/ml) than those with LTBI (median 1.96 IU/ml). IFN-γ response to mitogen increased with age. The overall rate of indeterminate results was low (3.9%), and no indeterminate QFT-IT values were observed in active or latent TB patients. In conclusion, quantitative QFT-IT values could provide further information to clinicians to manage TB in children, and these observations could be transferred to the new version of the test, QuantiFERON-TB Gold Plus, which to date lacks data from the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

et al. 2018

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“…25 Transaminase levels more than five times the normal upper limit are considered a sign of hepatotoxicity, and IPT should be discontinued. 7 There is no universally accepted threshold to describe hyperuricemia in children and adolescents. 26 In children, hyperuricemia is generally defined as a SUA level of >7 mg/dL and may result from overproduction or underexcretion of uric acid.…”

Section: Discussionmentioning

confidence: 99%

“…In older children and adolescents, if TST and IGRA are positive and chest X-ray is negative, IPTshould continue for 6 to 9 months. 4,7 Isoniazid is an essential drug in the chemotherapy of TB. Isoniazid for 6 to 9 months is the most widely used form of TB preventive treatment.…”

Section: Introductionmentioning

confidence: 99%

Unnoticed Adverse Effect of Isoniazid during Childhood Tuberculosis Preventive Treatment: Hyperuricemia

Kandemir

Duman

Durduran

et al. 2021

Journal of Pediatric Infectious Diseases

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Objective Isoniazid for 6 to 9 months is the most widely used form of tuberculosis (TB) preventive treatment. We aimed to assess the adverse effects of isoniazid by using the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), and uric acid (SUA) in children and adolescents receiving long-term isoniazid for latent TB infection. Methods The study included children ≤18 years of age who underwent TB preventive treatment with isoniazid (IPT) between 2015 and 2019 at a university hospital. Serum transaminase, SUA, urea, and creatinine levels of patients were measured before the initiation of IPT, 15th day, and once a month during treatment. Patients with ALT, AST, or SUA results above cut-off levels during treatment were evaluated. The final values in follow-up were included in the data analysis. Results A total of 141 children who underwent IPT were included. In total, 70 children had family members with confirmed TB disease, and 71 children had a positive tuberculin skin test. SUA increased above cut-off values in 16 children (11.3%), and half of them had uric acid levels over 7 mg/dL. The median duration of the development of hyperuricemia was 4.0 months. ALT or AST increased above cut-off values in 23 children (16.3%). ALT was above cut-off values in seven patients, AST was high in 20 patients. The median duration to the development of AST and/or ALT levels above cut-off was 4.0 months. Two patients had hepatotoxic transaminase levels. Three patients had both elevated transaminases and SUA levels. Conclusion Isoniazid may also cause hyperuricemia besides elevation in transaminases in children.

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“…Children who live in smokers are also more at risk of Tb infection (Laghari et al, 2019). The family plays a critical role in preventing the transmission of Tb to children (Lancella et al, 2015). Previous analysis showed that some variables were found to be insignificant because of the existence of other variables that were probable to play a role (Nurjana, Gunawan, & Tjandrarini, 2019).…”

Section: Introductionmentioning

confidence: 99%

The Relationship between External and Internal Risk Factors with Pulmonary Tuberculosis in Children Aged 0-59 Months in Slums in Indonesia, 2013

Nurjana¹,

Gunawan²,

Tjandrarini³

et al. 2020

GJHS

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BACKGROUND: Tuberculosis (Tb) remains a health problem throughout the world. World Health Organization (WHO) has set it as a “Global Emergency” disease. The difficulty of confirming the diagnosis of it in children, different from it in adults, causes the treatment of it in children often neglected. This problem is exacerbated by the supporting environmental conditions, namely living in slums, which makes the risk of transmission even higher. OBJECTIVE: To identify internal and external factors related to Tb in children aged 0-59 months living in slums in Indonesia. MATERIAL & METHOD: The data source used was the 2013 Basic Health Research (Riskesdas) using a sample of children less than five years old who lived in slums in 34 provinces in Indonesia. RESULTS: Logistic regression analysis found three risk factors, namely BCG immunization status (age-based), at-risk home environment, and gender (residential area-based). Vaccinated children under one year of age have the best probability of not suffering from pulmonary tuberculosis. Those who live in a house inhabited by less than five people, or in that occupied by more than four with no one of which smokes or does not suffer from pulmonary tuberculosis has a probability of not being exposed to it. Likewise, women who live in rural areas have almost two times less probability of suffering from it, compared to men in urban areas. CONCLUSION: Factors contributing to the prevalence of pulmonary tuberculosis in infants in slums are the status of BCG immunization, air cleanliness in the neighborhood, which can be seen from the differences of risks in rural and urban, and the number of inhabitants per house and their behavior.

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How to manage children who have come into contact with patients affected by tuberculosis

Cited by 14 publications

References 51 publications

Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

Unnoticed Adverse Effect of Isoniazid during Childhood Tuberculosis Preventive Treatment: Hyperuricemia

The Relationship between External and Internal Risk Factors with Pulmonary Tuberculosis in Children Aged 0-59 Months in Slums in Indonesia, 2013

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