Use of tuberculin skin test for assessment of immune recovery among previously malnourished children in Ethiopia

Abstract

ObjectiveTo compare levels of immunity in children recovering from severe acute malnutrition (cases) against those of community controls (controls).ResultsAt baseline children recovering from severe acute malnutrition had lower, mid upper arm circumference (122 mm for cases and 135 mm for controls; p < 0.001), weight-for-height Z-score (− 1.0 for cases and − 0.5 for controls; p < 0.001), weight-for-age Z-score (− 2.8 for cases and − 1.1 for controls; p < 0.001) and height/length-for-age Z-score (− 3.6 for cases and − 1.4 for controls; p < 0.001), than controls. Age and gender matched community controls. At baseline, prevalence of a positive tuberculin skin test, assessed by cutaneous delayed-type hypersensitivity reaction skin test, was very low in both cases (3/93 = 3.2%) and controls (2/94 = 2.1%) and did not significantly increase at 6 months follow up (6/86 = 7.0% in cases and 3/84 = 3.4% in controls). The incidences of common childhood morbidities, namely fever, diarrhoea and cough, were 1.7–1.8 times higher among cases than controls. In conclusion, these results show that tuberculin skin test does not enable any conclusive statements regarding the immune status of patients following treatment for severe acute malnutrition. The increased incidence of infection in cases compared to controls suggests persistence of lower resistance to infection even after anthropometric recovery is achieved.

Soya, maize and sorghum ready-to-use therapeutic foods are more effective in correcting anaemia and iron deficiency than the standard ready-to-use therapeutic food: randomized controlled trial

“…This study also provided evidence that current anthropometric discharge criteria are not a good proxy for attainment of homeostasis for iron, with anthropometric discharge criteria being met before a significant proportion of children attains replenished BIS, especially those who were depleted at the start of treatment. Similar issues have been shown in a recent study on immunity in children recovering from SAM [92], and taken together indicate the need for further research to determine the optimum criteria of discharging children that takes into account the fact that RUTF intake should not be prolonged unnecessarily given its high content of fat and other nutrients, and the need to minimize risk of relapse due to excessive morbidity. In parallel to the determination of new discharge criteria, there is a need to accelerate research aiming at determining which follow up intervention may ensure post-discharge recovery of iron homeostasis.…”

The relationship between lymphocyte subsets, nutritional status and tuberculin reactivity in continuous ambulatory peritoneal dialysis and hemodialysis patients

“…They concluded that the incidence of anergy increased with the duration of dialysis. Delayed cutaneous hypersensitivity to microbial or protein antigens is commonly depressed in uremic patients (50-60%) compared to healthy controls [1,[3][4][5]10]. In our study, we found that the prevalence of PPD positivity in chronic HD and PD patients was %46.6 and %53.3, respectively.…”

“…However, the major defect is generally detected in the cellular immune system in which T-lymphocytes have an important role [2]. Defective cell-mediated immunity, as reflected by anergy to multiple skin test antigens, is well documented in patients with protein-calorie malnutrition [3]. Skin test anergy is also common in patients with uremia and during maintenance hemodialysis treatment [4].…”

Follow-up between 6 and 24 months after discharge from treatment for severe acute malnutrition in children aged 6-59 months: A systematic review

“…High levels of morbidity, in particular diarrhoeal and respiratory illnesses, were reported in all three studies that measured morbidity [ 28 , 31 , 33 ]. A study in Ethiopia that followed-up children six months post-discharge found that there was approximately a 1.7 times higher incidence of fever, diarrhoea and cough in children discharged as cured compared to controls [ 39 ]. The synergistic effect of malnutrition and infection on risk of mortality is well-documented, and this review furthermore highlights the potential need for additional care for recovered malnourished children in order to prevent infection, as vulnerability to infection is still present despite recovery in WHZ [ 40 ].…”