What steps do we need to take to improve diagnosis of tuberculosis in children?

Abstract

Tuberculosis still represents a big global public health challenge. The diagnosis of tuberculosis and the differentiation between active and latent tuberculosis remain difficult, particularly in childhood, because of the lack of a gold standard test for diagnosis. In the last decade, novel diagnostic assays have been developed. Among immunologic tests, new assays based on the measurement of different cytokines released by specific T cells in response to Mycobacterium tuberculosis antigens, other than INF-γ, have been investigated. Promising results rely on nucleic acid amplification techniques, also able to detect drugs resistance. Innovative research fields studied the modifications of CD27 expression in T cells as well as different host gene expression in response to M. tuberculosis. Further studies are needed to assess the diagnostic value and the accuracy of these new assays.

Pediatric Tuberculosis in Italian Children: Epidemiological and Clinical Data from the Italian Register of Pediatric Tuberculosis

“…Therefore, even if our multicenter study was not specifically designed to investigate the performance of IGRAs, we can conclude that the combination of these tests become of a very large use in our setting. In fact, guidelines recommend that combinations of the available tests (immunological, radiological and microbiological) be performed in children in order to increase the diagnostic rate [ 20 , 21 , 22 , 23 ].…”

Binding of Bacteria to Poly(N-isopropylacrylamide) Modified with Vancomycin: Comparison of Behavior of Linear and Highly Branched Polymers

“…The development of simple to use devices for identification of pathogenic bacteria is an important goal in the global efforts to minimize the use of antibiotics. 1−3 Early detection of pathogens is critical in all areas of treatment of infective diseases, and recent reviews have been published that address the following: wound management, 4 urology, 5 tuberculosis, 6 blood-based infections, 7 food production, 8−10 and the supply of drinking water. 11 A number of approaches to such devices are possible, and we have introduced the idea that stimulus responsive polymers, based on poly(N-isopropylacrylamide) (PNIPAM), could be designed to respond to the presence of bacteria.…”

“…The development of simple to use devices for identification of pathogenic bacteria is an important goal in the global efforts to minimize the use of antibiotics. − Early detection of pathogens is critical in all areas of treatment of infective diseases, and recent reviews have been published that address the following: wound management, urology, tuberculosis, blood-based infections, food production, − and the supply of drinking water . A number of approaches to such devices are possible, and we have introduced the idea that stimulus responsive polymers, based on poly­( N -isopropylacrylamide) (PNIPAM), could be designed to respond to the presence of bacteria. − Several other possibilities are under investigation, including DNA based biosensors, , the use of fluorescently labeled lysozyme, antibodies fabricated into microfluidic devices, agglutination of nanoparticles, the use of paper based devices, and the measurement of the autofluorescence of infecting bacteria .…”

Tuberculose em crianças: desafios no diagnóstico

“…Os estudos apontam sobre algumas limitações no diagnóstico da TB em crianças, dentre elas há a dificuldade em obter amostras de escarro, principalmente em indivíduos com menos de 5 anos por, geralmente, não conseguirem expectorar; a inespecificidade das manifestações clínicas iniciais que podem ser confundidas com outros quadros infecciosos ou até mesmo uma desnutrição e, muitas vezes, a suspeita de TB só ocorre nos casos de pneumonia que não apresenta melhora com o uso de antibióticos para microorganismos comuns (Chen et al, 2013;Chiappini et al, 2016;Cruz & Velásquez, 2012;Graham, 2011;Laniado-Laborin, 2015;Perez-Porcuna et al, 2012;Rahman et al, 2012;Rossoni;Reuter;Sant'Anna, 2012;Shingadia, 2012;Venturini et al, 2015).…”

“…A detecção de lipoarabinomannan na urina tem baixa sensibilidade e especificidade, não sendo recomendado para o diagnóstico de TB pulmonar em crianças. Venturini et al, 2015 Fornecer uma visão geral atualizada dos novos testes para diagnóstico de TB em crianças, suas vantagens potenciais em relação aos testes diagnósticos já disponíveis e suas limitações TST; IGRAs; Cultura de escarro;…”