NCT
HOME CURRENT ARCHIVE COVID-19
HOME CURRENT ARCHIVE PUBLISH INSTRUCTIONS
FOR AUTHORS COVID-19 LOG IN / REGISTER HISTORY ABOUT US DIRECTORY CONTACT
Diagnosis of childhood tuberculosis at INER in 2015-2017

Carreto-Binaghi, Laura Elena , Juárez, Esmeralda , Guzmán-Beltrán, Silvia , Herrera, María Teresa , Torres, Martha , Sarabia, Carmen , Alejandre, Alejandro , González, Yolanda





2018, Number 4

2018; 77 (4)






ABSTRACT

Background: Childhood tuberculosis (TB) is a health problem because it accounts for 10% of TB cases worldwide. Despite the usage of medical practice guidelines for children with suspected TB, diagnosis is difficult due to its paucibacillary nature, the diverse clinical presentation and the available microbiologic and immunologic diagnostic tests. Material and methods: We reviewed the clinical records of pediatric patients hospitalized at INER during 2015-2017 period with diagnosis of TB, analyzing the demographic data, BCG vaccination, clinical chart; the results of laboratory, immunological and specific diagnostic tests for M. tuberculosis, and the therapeutic choice. Results: We described data from 22 patients, with a mean age of 7.3 ± 4.7 years and a male: female ratio of 1:1.2. All patients lived in Mexico City and its adjoining area; 63.6% of children were vaccinated with BCG, 59.1% were in contact with a TB adult patient, and 13.6% had an underlying disease. The most frequent clinical symptoms were cough, fever and weight loss. Laboratory data were normal in most cases. TB culture was positive in 59.1% of cases, baciloscopy in 27.8% of cases and molecular biology in 36.8% of cases. Regarding the immunological analyses, the tuberculin skin test (TST) was positive in 68.8%, while interferon gamma release assays (IGRA) were only performed in two cases. The most frequent clinical presentation was pulmonary TB (63.6% of cases). TB treatment was offered in 81.8% of cases; two patients were treated with second-line drugs due to contact with multidrug-resistant TB (MDR-TB), regardless of TB microbiological confirmation. Not all TB diagnostic tests available or routine immunological screening were performed in all patients, due to sample restriction or practitioner judgement. Conclusions: More clinical research studies are needed to improve the diagnosis of childhood TB and to support an adequate therapeutic decision for each patient. In this paper, we propose an algorithm for evaluating pediatric patients with suspected TB.

KEYWORDS

Diagnosis, pediatric patients, tuberculosis.

REFERENCES

  1. World Health Organization. Global Tuberculosis Report 2016. Génova, Suiza; 2016. Fecha de acceso: 05 de junio, 2018. Disponible en http://www.who.int.

  2. World Health Organization. Fact sheet on tuberculosis (updated January 2018). Wkly Epidemiol Rec 2018;93(4-5):39-43.

  3. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis 2008;8(8):498-510. doi: 10.1016/S1473-3099(08)70182-8.

  4. Ho TS, Wang SM, Shen CF, Lee KH, Liu CC. Clinical perspectives of childhood tuberculosis in Taiwan. J Formos Med Assoc 2011;110(12):737-743. doi: 10.1016/j.jfma.2011.11.002.

  5. Tsai KS, Chang HL, Chien ST, et al. Childhood tuberculosis: epidemiology, diagnosis, treatment, and vaccination. Pediatr Neonatol 2013;54(5):295-302. doi: 10.1016/j.pedneo.2013.01.019.

  6. Faddoul D. Childhood tuberculosis: an overview. Adv Pediatr 2015;62(1):59-90. doi: 10.1016/j.yapd.2015.04.001.

  7. Ramos S, Gaio R, Ferreira F, et al. Tuberculosis in children from diagnosis to decision to treat. Rev Port Pneumol 2006;23(6):317-322. doi: 10.1016/j.rppnen.2017.06.004.

  8. World Health Organization, Stop TB department. Treatment of tuberculosis guidelines. Fourth edition. Génova, Suiza; 2010. Fecha de acceso: 5 de junio, 2018. Disponible en http://www.who.int.

  9. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016;63(7):e147-e195. doi: 10.1093/cid/ciw376.

  10. Marais BJ, Pai M. Recent advances in the diagnosis of childhood tuberculosis. Arch Dis Child 2007;92(5):446-452.

  11. Sandgren A, Hollo V, Quinten C, Manissero D. Childhood tuberculosis in the European Union/European Economic Area, 2000 to 2009. Euro Surveill 2011;16(12). pii:19825.

  12. Marais BJ, Schaaf HS. Childhood tuberculosis: an emerging and previously neglected problem. Infect Dis Clin North Am 2010;24(3):727-749. doi: 10.1016/j.idc.2010.04.004.

  13. Kampmann B, Whittaker E, Williams A, et al. Interferon-gamma release assays do not identify more children with active tuberculosis than the tuberculin skin test. Eur Respir J 2009;33(6):1374-1382. doi: 10.1183/09031936.00153408.

  14. Kampmann B, Tena-Coki G, Anderson S. Blood tests for diagnosis of tuberculosis. Lancet 2006;368(9532):282.

  15. Sieiro TLA, Aurílio RB, Soares ECC, Chiang SS, Sant Anna CC. The role of the Xpert MTB/RIF assay among adolescents suspected of pulmonary tuberculosis in Rio de Janeiro, Brazil. Rev Soc Bras Med Trop 2018;51(2):234-236. doi: 10.1590/0037-8682-0298-2017.

  16. Gutierrez C. Benefits and challenges of molecular diagnostics for childhood tuberculosis. Int J Mycobacteriol 2016;5 Suppl 1:S4-S5. doi: 10.1016/j.ijmyco.2016.08.011.

  17. Marais BJ, Graham SM, Maeurer M, Zumla A. Progress and challenges in childhood tuberculosis. Lancet Infect Dis 2013;13(4):287-289. doi: 10.1016/S1473-3099(13)70031-8.

  18. Schaaf HS, Marais BJ. Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians. Paediatr Respir Rev 2011;12(1):31-38. doi: 10.1016/j.prrv.2010.09.010.

  19. Organización Panamericana de la Salud, Organización Mundial de la Salud. Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud. Décima Revisión. Washington D.C., E.U.; 2015. Accesible en: http://www.who.int/classifications/icd/en/.

  20. González-Saldaña N, Macías-Parra M, Hernández-Porras M, Gutiérrez-Castrellón P, Gómez-Toscano V, Juárez-Olguin H. Pulmonary tuberculous: symptoms, diagnosis and treatment. 19-year experience in a third level pediatric hospital. BMC Infect Dis 2014;14:401. doi: 10.1186/1471-2334-14-401.

  21. Bustamante J, Boisson-Dupuis S, Abel L, Casanova JL. Mendelian susceptibility to mycobacterial disease: genetic, immunological, and clinical features of inborn errors of IFN-γ immunity. Semin Immunol 2014;26(6):454-470. doi: 10.1016/j.smim.2014.09.008.

  22. Pedraza-Sánchez S, Herrera-Barrios MT, Aldana-Vergara R, et al. Bacille Calmette-Guérin infection and disease with fatal outcome associated with a point mutation in the interleukin-12/interleukin-23 receptor beta-1 chain in two Mexican families. Int J Infect Dis 2010;14 Suppl 3:e256-e260. doi: 10.1016/j.ijid.2009.11.005.

  23. Conti F, Lugo-Reyes SO, Blancas-Galicia L, et al. Mycobacterial disease in patients with chronic granulomatous disease: A retrospective analysis of 71 cases. J Allergy Clin Immunol 2016;138(1):241-248.e3. doi: 10.1016/j.jaci.2015.11.041.

  24. Kampmann B, Whittaker E, Williams A, et al. Interferon-gamma release assays do not identify more children with active tuberculosis than the tuberculin skin test. Eur Eur Respir J. 2009;33(6):1374-1382. doi: 10.1183/09031936.00153408.

  25. Starke JR; Committee on Infectious Diseases. Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children. Pediatrics 2014;134(6):e1763-e1773. doi: 10.1542/peds.2014-2983.

  26. Kasambira TS, Shah M, Adrian PV, et al. QuantiFERON-TB Gold In-Tube for the detection of Mycobacterium tuberculosis infection in children with household tuberculosis contact. Int J Tuberc Lung Dis 2011;15(5):628-634. doi: 10.5588/ijtld.10.0555.

  27. Chiang SS, Swanson DS, Starke JR. New diagnostics for childhood tuberculosis. Infect Dis Clin North Am 2015;29(3):477-502. doi: 10.1016/j.idc.2015.05.011.

  28. Cruz AT, Starke JR, Lobato MN. Old and new approaches to diagnosing and treating latent tuberculosis in children in low-incidence countries. Curr Opin Pediatr 2014;26(1):106-113. doi: 10.1097/MOP.0000000000000049.

  29. Martinez L, Shen Y, Handel A, et al. Effectiveness of WHO’s pragmatic screening algorithm for child contacts of tuberculosis cases in resource-constrained settings: a prospective cohort study in Uganda. Lancet Respir Med 2018;6(4):276-286. doi: 10.1016/S2213-2600(17)30497-6.

  30. Marais BJ. Symptom-based screening of children with household tuberculosis contact. Lancet Respir Med 2018;6(4):235-237. doi: 10.1016/S2213-2600(17)30496-4.


2018, Number 4

2018; 77 (4)