Non-Tuberculous Mycobacterial Diseases in Children

Abstract

<jats:p>Non-tuberculous mycobacteria (NTMs) are ubiquitous and opportunistic emerging bacteria with the potential to colonize and eventually infect either immunocompromised or immunocompetent individuals. In the last three decades, the prevalence of disease caused by NTMs has increased in several countries. The increased prevalence of NTM infection can be explained by an ageing population with rising comorbidities, HIV infection, the common use of immunosuppressive drugs, and improved diagnostic methods. The aim of this review is to demonstrate the clinical relevance of NTMs in children, describing their features and manifestations, diagnostic tools, and therapeutic approaches. We collected data from the literature about NTM infections in young patients over the past five years (2014–2019) using the keywords “non-tuberculous”, “mycobacteria”, “paediatric”, “NTM”, “cystic fibrosis”, and “children”. Recent literature points out that NTMs are ubiquitous, with several species including both those that are pathogens for humans and those that are not. This means that, if a mycobacterium is isolated from a patient’s specimen, we have to distinguish between a simple colonization and an NTM-related disease. The start of treatment depends on many factors that are necessary to consider, such as clinical and imaging features, patient comorbidity and immunocompetence, drug adverse effects, and compliance with a very long therapy that can last many months. Due to the increasing prevalence and clinical relevance of NTMs, guidelines for their optimal management, especially in the presence of chronic underlying disease, are urgently needed.</jats:p>

Mental health disorders among students from rural areas three months after returning to school: a cross-sectional study among Polish students (12-13 y.o.)

“…The conducted research shows that worse mental health was observed among female students, which is also confirmed by many other studies [26,27]. Lower financial status of a household may have a negative impact on the possibility of satisfying one's needs connected with autonomy, privacy or access to distance education; therefore, they are reflected in worse mental health among children and adolescents from poorer families [28]. The collected data also indicates that the students from rural areas display mental health disorders more often than students from urban areas, which may constitute a confirmation of the above thesis.…”

Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population

“…A systematic review has shown that while sensitivity for each method is relatively low (41.8% for culture, 71.6% for PCR), both have a specificity of 100%, making them reliable for confirming the diagnosis [25]. Notably, the source for these tests matters -culture sensitivity varies from 45% for fine needle aspiration (FNA) to up to 80% for purulent discharge, compared with up to 92% for PCR from FNA or lymph node biopsy [21,26]. Hence, given widespread availability of PCR, its higher sensitivity, and that cultures can take up to six weeks [27], we recommend adding NTM PCR to the diagnostic workup when available.…”

“…A TST checks for induration, which is indicative of an immune response after intradermal injection of purified protein derivatives (PPD) from M. tuberculosis but can also have a positive result with NTM exposure, whereas IGRA detects the release of IFN-γ from a patient's sensitized white blood cells that have been exposed to M. tuberculosis specifically [19]. Hence, a positive TST and negative IGRA in a BCG (bacille Calmette-Guerin)-unvaccinated, immunocompetent child is suggestive of NTM infection [20 ▪▪ ,21,22]. However, NTM can result in nonspecific reactions to TSTs, making interpretation difficult, not to mention their declining use, leaving fewer clinicians skilled in its placement and interpretation [23 ▪ ,24].…”

Non-Tuberculous Mycobacteria Interference with BCG-Current Controversies and Future Directions

“…It is well established that the protective efficacy of BCG varies depending on which geographical region it is administered, and we know very little about why it protects when it does or why it fails to protect when it does not. Although a lot of progress has been made, the past two decades have revealed that there is no correlate of BCG-induced protection against TB even though evidence supporting T-cells, IFN-γ, TNF-alpha, and humoral immunity are clearly required [ 63 ].…”