The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community

Marais, Ben J; Obihara, C C; Gie, Robert P.; Schaaf, H. Simon; Hesseling, Anneke C.; Lombard, Carl; Enarson, Donald A.; Bateman, Eric D.; Beyers, Nulda

doi:10.1136/adc.2004.060640

Cited by 61 publications

(60 citation statements)

References 15 publications

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“…The clinical presentation of childhood TB varies according to age, with higher rates of dissemination in early childhood and a more adult-like presentation in adolescents (16,26,35,37,40,50,61), which is likely a reflection of the maturity of the immune system. Data indicate that Ab responses in children, just as in adults, vary according to clinical manifestations.…”

Section: Antibody Responses According To Type Of Tbmentioning

confidence: 99%

“…Furthermore, during the first year of life, serum IgG is likely to reflect the maternal Abs transferred in utero. In addition, the clinical presentation of TB varies according to age, with higher rates of dissemination in early childhood and a more adult-like presentation in adolescents (16,26,35,37,40,50,61). Taking each of these aspects into account, it would be most sensible to categorize children into age groups such as (i) less than 1 year, (ii) 1 to 2 years, (iii) 2 to 5 years, (iv) 5 to 10 years, and (v) over 10 years when conducting future TB serology studies.…”

Section: Limitations Of and Aspects To Consider In Serological Studiementioning

confidence: 99%

See 1 more Smart Citation

Antibody Responses to Mycobacterial Antigens in Children with Tuberculosis: Challenges and Potential Diagnostic Value

Achkar

Ziegenbalg

2012

Clin Vaccine Immunol

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The identification of easily detectable biomarkers for active tuberculosis (TB) is a global health priority. Such biomarkers would be of particular value in childhood TB, which poses greater diagnostic challenges than adult TB. Serum antibodies can be detected by simple formats that provide extremely rapid results. However, attempts to develop accurate serodiagnostic tests for TB have been unsuccessful. Whereas antibody responses to mycobacterial antigens in adult TB have been studied extensively and reviewed, the same cannot be said for serologic data in pediatric populations. Here we appraise studies on serological responses in childhood TB and discuss findings and limitations in the context of the developing immune system, the age range, and the spectrum of TB manifestations. We found that the antibody responses to mycobacterial antigens in childhood TB can vary widely, with sensitivities and specificities ranging from 14% to 85% and from 86% to 100%, respectively. We conclude that the limitations in serodiagnostic studies of childhood TB are manifold, thereby restricting the interpretation of currently available data. Concerns about the methodology used in published studies suggest that conclusions about the eventual value of serodiagnosis cannot be made at this time. However, the available data suggest a potential adjunctive value for serology in the diagnosis of childhood TB. Despite the difficulties noted in this field, there is optimism that the application of novel antigens and the integration of those factors which contribute to the serological responses in childhood TB can lead to useful future diagnostics.A ctive tuberculosis (TB) is a major cause of morbidity and mortality in children, especially in resource-limited countries, in which children under the age of 15 years account for approximately 15 to 20% of the disease burden (19,39). Infection with Mycobacterium tuberculosis in children is generally the consequence of household transmission from an adult incident case. Thus, it is not surprising that 75% of the estimated 1 million annual pediatric TB cases occur in the 22 high-burden countries (69). While adult TB is commonly due to reactivation, pediatric TB is typically a primary disease. In addition, there are considerable differences in host immune responses between adults and young children. The results are a more atypical clinical manifestation with a paucity of classical signs and symptoms in pediatric TB, resulting in considerably higher challenges to establish TB diagnosis than in adults.In young children, TB frequently disseminates and can be rapidly progressive early in life before immune competency is fully developed (36). Therefore, diagnostic delay quickly leads to increased morbidity and mortality, and rapid diagnosis becomes particularly important. However, the differences in disease manifestation of pediatric and adult TB result in reduced sensitivities for TB diagnostic tests. For example, cavitary disease is uncommon in children while up to 30% have extrapulmonary manifestations...

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Section: Antibody Responses According To Type Of Tbmentioning

confidence: 99%

Section: Limitations Of and Aspects To Consider In Serological Studiementioning

confidence: 99%

Antibody Responses to Mycobacterial Antigens in Children with Tuberculosis: Challenges and Potential Diagnostic Value

Achkar

Ziegenbalg

2012

Clin Vaccine Immunol

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“…It is caused by intracellular bacilli Mycobacterium tuberculosis and lungs are most frequently affected organs [2].…”

mentioning

confidence: 99%

Health care workers humoral immune response against GLcB, MPT51 and HSPX from Mycobacterium tuberculosis

Reis¹,

Rabahi²,

Kipnis³

et al. 2009

Braz J Infect Dis

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Tuberculosis (TB) is one of the oldest human infectious diseases and one third of the world's population is latently infected. Brazil is an endemic area for TB. One of the most important challenges in TB control is the identification of latently infected individuals. Health Care Workers (HCW) are at high risk of being infected with Mycobacterium tuberculosis and even to become TB latently infected. The aim of this study was to increase knowledge about humoral immune response in TB latently infected individuals. HCW were classified according to their tuberculin skin test (TST), as positive or negative. The antibody response to GLcB, MPT51 and HSPX from Mycobacterium tuberculosis was evaluated. TST negative HCW constituted the majority of those who showed a humoral immune response. Antibody levels varied according to antigen characteristics, TST and BCG status. We suggest that possibly the presence of those antibodies could have a function in the protective immune response against Mycobacterium tuberculosis.

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“…The candidate predictors of active TB disease in this study were selected based on judgement of their relevance to the clinical presentation of childhood TB, ease of ascertainment and from published reports relevant to the epidemiology of childhood TB in resource-limited settings [23,26]. As expected, we found no difference between children with active TB disease and other disease in our study in the prevalence of chest radiographs with abnormality reported as consistent with active TB disease, given the poor specificity of chest radiography in childhood TB.…”

Section: Discussionmentioning

confidence: 99%

No added value of interferon-γ release to a prediction model for childhood tuberculosis

et al. 2015

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The predictive value of a combination of clinical and radiological features with interferon-γ release assay (IGRA) for diagnosis of active tuberculosis (TB) disease among TB-exposed children is unknown.150 symptomatic HIV-negative children (aged 3 months to 14 years), prospectively recruited through active contact tracing, were included. Backward stepwise logistic regression and bootstrapping techniques were used for the development and internal validation of a clinical prediction model for active TB disease. Model discrimination and incremental value of a positive IGRA test were assessed by area under the receiver operating characteristic curve (AUC).35 (23%) children were diagnosed with active TB disease and started on treatment and 115 (77%) had other respiratory tract infections. A final parsimonious clinical model, comprising age <5 years (adjusted (a)OR 4.8, 95% CI 2.0-11.5) and lymphadenopathy on clinical examination (aOR 4.9, 95% CI 1.8-13.0) discriminated active TB disease from other disease with an AUC of 0.70 (95% CI 0.61-0.80). A positive IGRA result did not improve the discriminatory ability of the clinical model (c-statistic 0.72 versus 0.70; p=0.644).A clinical algorithm, including age <5 years and lymphadenopathy classified 70% of active TB disease among symptomatic TB-exposed children. IGRA does not add any discriminatory value to this prediction model. @ERSpublicationsNo added value of interferon-γ release to a prediction model for childhood TB in TB-exposed children

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The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community

Cited by 61 publications

References 15 publications

Antibody Responses to Mycobacterial Antigens in Children with Tuberculosis: Challenges and Potential Diagnostic Value

Antibody Responses to Mycobacterial Antigens in Children with Tuberculosis: Challenges and Potential Diagnostic Value

Health care workers humoral immune response against GLcB, MPT51 and HSPX from Mycobacterium tuberculosis

No added value of interferon-γ release to a prediction model for childhood tuberculosis

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