Recent advances in the diagnosis and treatment of childhood tuberculosis

Kumar, Mani Kant; Kumar, Prashant; Singh, Anjali

doi:10.4103/0976-9668.159988

Cited by 31 publications

(32 citation statements)

References 39 publications

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“…Children with TB are often not diagnosed and reported because of limited capacity of frontline health providers [4,5], lack of dedicated child health services with experienced and appropriately trained clinicians [4], non-specific symptoms overlapping with other common childhood diseases [6], complex diagnostic algorithms [6,7], lack of a sensitive point of care test and technical resources [8], and minimal contact tracing activities [2].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Funding on Childhood TB Case Detection in Pakistan

Malik

Hussain²,

Creswell³

et al. 2019

TropicalMed

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This study is a review of routine programmatically collected data to describe the 5-year trend in childhood case notification in Jamshoro district, Pakistan from January 2013 to June 2018 and review of financial data for the two active case finding projects implemented during this period. The average case notification in the district was 86 per quarter before the start of active case finding project in October 2014. The average case notification rose to 322 per quarter during the implementation period (October 2014 to March 2016) and plateaued at 245 per quarter during the post-implementation period (April 2016 to June 2018). In a specialized chest center located in the district, where active case finding was re-introduced during the post implementation period (October 2016), the average case notification was 218 per quarter in the implementation period and 172 per quarter in the post implementation period. In the rest of the district, the average case notification was 160 per quarter in the implementation period and 78 during the post implementation period. The cost per additional child with TB found ranged from USD 28 to USD 42 during the interventions. A continuous stream of resources is necessary to sustain high notifications of childhood TB.

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Section: Introductionmentioning

confidence: 99%

The Impact of Funding on Childhood TB Case Detection in Pakistan

Malik

Hussain²,

Creswell³

et al. 2019

TropicalMed

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“…Nevertheless, diagnosis of TB in children is challenging due to its nonspecific clinical presentation and its paucibacillary nature as well as the frequent extrapulmonary localization of the disease. Current pediatric guidelines recommend applying a combination of clinical, radiological, microbiological, and immunological approaches to improve the diagnostic yield (2)(3)(4).…”

mentioning

confidence: 99%

Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

et al. 2018

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The use of interferon gamma (IFN-γ) release assays (IGRAs) for the diagnosis of tuberculosis (TB) infection in children is still under debate because of concerns about the immature immune response in children. The aim of this study was to investigate quantitative values of the QuantiFERON-TB Gold In-Tube (QFT-IT) test, a commercially available IGRA, in a large cohort of children screened for TB infection. A retrospective analysis was conducted on samples from 517 children aged 0 to 14 years old at the Pediatric Unit of S. Orsola-Malpighi University Hospital of Bologna (Italy); quantitative responses to QFT-IT stimuli were analyzed according to diagnosis and age. Elevated IFN-γ values in the QFT-IT nil (background) tube were statistically associated with diagnosis of active TB. Quantitative IFN-γ response to -specific antigens (TB Ag) was not significantly different in children with active TB compared to those with latent TB infection (LTBI), even though the median values were higher in the first group. When children were grouped by age, those less than 5 years old produced significantly higher levels of IFN-γ in response to TB Ag if they had active TB (median 10 IU/ml) than those with LTBI (median 1.96 IU/ml). IFN-γ response to mitogen increased with age. The overall rate of indeterminate results was low (3.9%), and no indeterminate QFT-IT values were observed in active or latent TB patients. In conclusion, quantitative QFT-IT values could provide further information to clinicians to manage TB in children, and these observations could be transferred to the new version of the test, QuantiFERON-TB Gold Plus, which to date lacks data from the pediatric population.

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“…This study indicated that diagnosis of childhood TB by private providers was mainly based on clinical features, radiography and microscopy, rarely tuberculin skin tests, histopathology and Gene-Xpert MTB/RIF. Other settings also show that TB diagnosis in children is often based on a combination of clinical symptoms and chest X-ray; this could be due to the lack of a simple and precise diagnostic tool especially at the peripheral level, or due to inadequate training and capacity of health care workers [13][14][15][16][17][18][19]. However, in Pakistan, the availability of diagnostic tools varies across the country, where chest X-ray and smear microscopy are almost universally available and used for TB diagnosis at peripheral level.…”

Section: Discussionmentioning

confidence: 99%

How do private practitioners in Pakistan manage children suspected having tuberculosis?

Yaqoob

Hinderaker

Fatima³

et al. 2020

Preprint

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Background:Private providers provide a large portion of health care in Pakistan, including tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision and support. Diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods:This cross-sectional study was based on a national survey that measured under-reporting of children with TB in 12 selected districts in Pakistan from Apr-Jun, 2016. We explored the practices of private health care providers, like general practitioners, pediatricians, pulmonologists and chest specialists, involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB.Results:Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG scar was more common in female children. Private providers relied on chest X-ray in 46.1%, but tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP).Conclusion:This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but cases identified in investigations were often not notified to the NTP. This problem needs to be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.

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Recent advances in the diagnosis and treatment of childhood tuberculosis

Cited by 31 publications

References 39 publications

The Impact of Funding on Childhood TB Case Detection in Pakistan

The Impact of Funding on Childhood TB Case Detection in Pakistan

Quantitative Analysis of Gamma Interferon Release Assay Response in Children with Latent and Active Tuberculosis

How do private practitioners in Pakistan manage children suspected having tuberculosis?

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