Pediatric and adolescent tuberculosis in Latvia, 2011–2014: case detection, diagnosis and treatment

Ziemele, Baiba; Ranka, Renāte; Ozere, Iveta

doi:10.5588/ijtld.16.0270

Cited by 14 publications

(12 citation statements)

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“…In the 1990's, CT scans revealed greater detail and coined the term “tree-in-bud” sign as the characteristic feature of advancing pulmonary TB ( 65 – 67 ). In the past few years, this has been confirmed by studies in South Africa and Latvia using CT and PET-CT ( 22 , 40 , 45 ).…”

Section: Functions Of Primary and Post-primary Tbmentioning

confidence: 64%

The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity

Hunter

2018

Front. Immunol.

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It has long been recognized that tuberculosis (TB) induces both protective and tissue damaging immune responses. This paper reviews nearly two centuries of evidence that protection and tissue damage are mediated by separate disease entities in humans. Primary TB mediates protective immunity to disseminated infection while post-primary TB causes tissue damage that results in formation of cavities. Both are necessary for continued survival of Mycobacterium tuberculosis (MTB). Primary TB has been extensively studied in humans and animals. Post-primary TB, in contrast, is seldom recognized or studied. It begins as an asymptomatic early infiltrate that may resolve or progress by bronchogenic spread to caseous pneumonia that either fragments to produce cavities or is retained to produce post-primary granulomas and fibrocaseous disease. Primary and post-primary TB differ in typical age of onset, histopathology, organ distribution, x-ray appearance, genetic predisposition, immune status of the host, clinical course and susceptibility to protection by BCG. MTB is a highly successful human parasite because it produces both primary and post-primary TB as distinct disease entities in humans. No animal reproduces this sequence of lesions. Recognition of these facts immediately suggests plausible solutions, animal models and testable hypotheses to otherwise inaccessible questions of the immunity and pathogenesis of TB.

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Section: Functions Of Primary and Post-primary Tbmentioning

confidence: 64%

The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity

Hunter

2018

Front. Immunol.

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“…The early pulmonary infiltrate, Assmann’s focus, is the lesion that represents the onset of PPTB, Figure 4 [ 54 ]. Worldwide interest in its significance stimulated numerous studies and publications through the 1940s and beyond [ 43 , 44 , 46 , 48 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. Multiple investigations confirmed that the early pulmonary infiltrate was a common onset of TB.…”

Section: X-rays Of Developing Tbmentioning

confidence: 99%

The Pathogenesis of Tuberculosis–The Koch Phenomenon Reinstated

Hunter

2020

Pathogens

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Research on the pathogenesis of tuberculosis (TB) has been hamstrung for half a century by the paradigm that granulomas are the hallmark of active disease. Human TB, in fact, produces two types of granulomas, neither of which is involved in the development of adult type or post-primary TB. This disease begins as the early lesion; a prolonged subclinical stockpiling of secreted mycobacterial antigens in foamy alveolar macrophages and nearby highly sensitized T cells in preparation for a massive necrotizing hypersensitivity reaction, the Koch Phenomenon, that produces caseous pneumonia that is either coughed out to form cavities or retained to become the focus of post-primary granulomas and fibrocaseous disease. Post-primary TB progresses if the antigens are continuously released and regresses when they are depleted. This revised paradigm is supported by nearly 200 years of research and suggests new approaches and animal models to investigate long standing mysteries of human TB and vaccines that inhibit the early lesion to finally end its transmission.

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“…The median number of contacts undergoing advanced imaging was relatively small, at 32. Twelve studies examined children to adolescents [ 13 – 16 , 18 , 21 , 23 – 25 , 27 , 28 , 30 ], while the other studies included adults. One study was conducted on contacts infected with HIV [ 35 ], while the other 24 studies were conducted in immunocompetent contacts.…”

Section: Main Textmentioning

confidence: 99%

“…One study was conducted on contacts infected with HIV [ 35 ], while the other 24 studies were conducted in immunocompetent contacts. Four studies partly [ 25 , 29 ] or entirely [ 23 , 26 ] included close contacts with drug-resistant TB. Bacterial and molecular testing with sputum or other specimens (e.g., gastric aspirates) generally yielded a low positivity rate in contacts with minimal CT or PET abnormalities, reflecting a low bacillary burden (Table 1 ).…”

Section: Main Textmentioning

confidence: 99%

“…When CT or PET abnormalities were identified, most of the studies initiated full regimens of anti-TB medication solely based on radiologic or metabolic abnormalities without bacteriological/molecular test positivity for active TB. Contacts with minimal CT or PET abnormalities were treated successfully, including a treatment success rate (successful treatment completion with or without bacteriological evidence of success [ 38 ]) of 100% in twenty-two contacts younger than 18 years exposed to multi- or extensively drug-resistant TB [ 25 ]. There were two similarly treated contacts exposed to multi-drug resistant TB in the literature [ 23 , 26 ].…”

Section: Main Textmentioning

confidence: 99%

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CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray

et al. 2022

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Close contacts of individuals with pulmonary tuberculosis are at risk for tuberculosis infection and the development of active tuberculosis. In current contact investigations, immunologic tests (the tuberculin skin test and interferon-gamma release assay) and chest X-ray examinations are used to dichotomize contacts with Mycobacterium tuberculosis infections into those with active (X-ray abnormalities) versus latent tuberculosis (normal radiographs). This article is a critical review of computed tomographic (CT) and 18-fluorodeoxyglucose positron emission tomographic (PET) findings of incipient tuberculosis without X-ray abnormalities based on a systematic literature review of twenty-five publications. The CT and 18-fluorodeoxyglucose PET studies revealed minimal pauci-nodular infiltrations in the lung parenchyma and mediastinal lymph nodes abnormalities with metabolic uptake in approximately one-third of asymptomatic close contacts with negative chest radiographic and bacteriological/molecular results for active tuberculosis. Tuberculosis with minimal changes challenge the validity of simply dichotomizing cases of recent M. tuberculosis infections in contacts depending on the presence of X-ray abnormalities as the recent infections may spontaneously regress, remain stagnant, or progress to active tuberculosis in human and nonhuman primate studies. Whether contacts with tuberculosis with minimal changes are interpreted as having active tuberculosis or latent tuberculosis has clinical implications in terms of specific benefits and harms under the current contact management. Advanced imaging tools may help further stratify contacts intensely exposed to M. tuberculosis on a continuous spectrum from latent tuberculosis to incipient, subclinical and active tuberculosis. Identifying incipient tuberculosis would provide an opportunity for earlier and tailored treatment before active tuberculosis is established.

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Pediatric and adolescent tuberculosis in Latvia, 2011–2014: case detection, diagnosis and treatment

Abstract: TB case detection through contact investigation provided early diagnosis and excellent treatment outcomes in children and adolescents in Latvia. CT was able to identify pathology consistent with subclinical TB in children with a history of exposure.

Cited by 14 publications

References 0 publications

The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity

The Pathogenesis of Tuberculosis: The Early Infiltrate of Post-primary (Adult Pulmonary) Tuberculosis: A Distinct Disease Entity

The Pathogenesis of Tuberculosis–The Koch Phenomenon Reinstated

CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray

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