UMOYA: a prospective longitudinal cohort study to evaluate novel diagnostic tools and to assess long-term impact on lung health in South African children with presumptive pulmonary TB—a study protocol

Dewandel, Isabelle; Niekerk, Margaret van; Ghimenton-Walters, Elisabetta; Palmer, Megan; Anthony, M. G.; McKenzie, Carla; Croucamp, Rolanda; Alter, Galit; Demers, Anne-Marie; Zyl, Gert van; Claassen, Mathilda; Goussard, Pierre; Swanepoel, Ruan; Hoddinott, Graeme; Bosch, Corné; Dunbar, Rory; Allwood, Brian; McCollum, Eric D.; Schaaf, H. Simon; Hesseling, Anneke C.; Zalm, Marieke M. van der

doi:10.1186/s12890-023-02329-3

Cited by 6 publications

(4 citation statements)

References 53 publications

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“…As performing spirometry on young children can be challenging, non-spirometry PFTs should be considered for children below certain ages and others on a case-by-case basis. At least one study has explored oscillometry for children above 2 years, alongside spirometry for those above 4 years of age 40. Subsequent findings may address the evidence gap for performing scheduled PFTs as part of national TB programmes or routine post-TB pulmonary health surveillance,11 especially in low-income to middle-income countries with significant disease burden.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis

Lew,

Tan,

Yerkovich

et al. 2023

Arch Dis Child

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BackgroundDespite tuberculosis (TB) being a curable disease, current guidelines fail to account for the long-term outcomes of post-tuberculosis lung disease—a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB).MethodsPubMed, ISI Web of Science, Cochrane Library and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsFrom 8040 records, 5 studies were included (involving n=567 children), with spirometry measures from 4 studies included in the meta-analyses. The effect sizes of childhood TB on forced expiratory volume in the first second and forced vital capacity z-scores were estimated to be −1.53 (95% CI −2.65, –0.41; p=0.007) and −1.93 (95% CI −3.35, –0.50; p=0.008), respectively.DiscussionThe small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, PFTs (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment.PROSPERO registration numberCRD42021250172.

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Section: Discussionmentioning

confidence: 99%

Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis

Lew,

Tan,

Yerkovich

et al. 2023

Arch Dis Child

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“…The sampling cohort in this study were from a population of infants and children (< 13 years) living in the Western Cape province of South Africa, a region well known for a high prevalence of TB [ 17 – 19 ]. Paediatric patients from primary and secondary healthcare service centres were referred to the paediatric department at the Tygerberg Hospital in Cape Town.…”

Section: Methodsmentioning

confidence: 99%

Urinary markers of Mycobacterium tuberculosis and dysbiosis in paediatric tuberculous meningitis cases undergoing treatment

Isaiah,

Loots,

van Furth

et al. 2024

Gut Pathog

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Background The pathogenesis of tuberculous meningitis (TBM) involves infection by Mycobacterium tuberculosis in the meninges and brain. However, recent studies have shown that the immune response and inflammatory processes triggered by TBM can have significant effects on gut microbiota. Disruptions in the gut microbiome have been linked to various systemic consequences, including altered immunity and metabolic dysregulation. Inflammation caused by TBM, antibiotic treatment, and changes in host immunity can all influence the composition of gut microbes. This complex relationship between TBM and the gut microbiome is of great importance in clinical settings. To gain a deeper understanding of the intricate interactions between TBM and the gut microbiome, we report innovative insights into the development of the disease in response to treatment. Ultimately, this could lead to improved outcomes, management strategies and quality of life for individuals affected by TBM. Method We used a targeted liquid chromatography–tandem mass spectrometry (LC-MS/MS) approach to investigate metabolites associated with gut metabolism in paediatric participants by analysing the urine samples collected from a control group (n = 40), and an experimental group (n = 35) with confirmed TBM, which were subdivided into TBM stage 1 (n = 8), stage 2 (n = 11) and stage 3 (n = 16). Findings Our metabolomics investigation showed that, of the 78 initially selected compounds of microbiome origin, eight unique urinary metabolites were identified: 2-methylbutyrlglycine, 3-hydroxypropionic acid, 3-methylcrotonylglycine, 4-hydroxyhippuric acid, 5-hydroxyindoleacetic acid, 5-hydroxyhexanoic acid, isobutyrylglycine, and phenylacetylglutamine as urinary markers of dysbiosis in TBM. Conclusion These results – which are supported by previous urinary studies of tuberculosis – highlight the importance of gut metabolism and of identifying corresponding microbial metabolites as novel points for the foundation of improved management of TBM patients.

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“…At least one study has explored oscillometry for children above two years, alongside spirometry for those above four years of age. 40 Subsequent findings may address the evidence gap for performing scheduled PFTs as part of national TB programmes or routine post-TB pulmonary health surveillance 11 , especially in low-to-middle income countries with significant disease burden.…”

Section: Clinical and Policy Implicationsmentioning

confidence: 97%

Pulmonary Function Outcomes after Tuberculosis treatment in Children: A Systematic Review and Meta-analysis

Lew,

Tan,

Yerkovich

et al. 2023

Preprint

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Background: Despite tuberculosis (TB) being a curable disease, current guidelines fail to account for long-term outcomes of post-tuberculosis lung disease (PTLD) - a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB). Methods: PubMed, ISI Web of Science, the Cochrane Library, and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: From 8040 records, five studies were included (involving n=567 children) with spirometry measures from four studies included into meta-analyses. The effect size of childhood TB on forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) z-scores were estimated to be -1.53 (95% CI: -2.65, -0.41; p=0.007) and -1.93 (95% CI: -3.35, -0.50; p=0.008) respectively. Discussion: The small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, pulmonary function tests (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment.

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UMOYA: a prospective longitudinal cohort study to evaluate novel diagnostic tools and to assess long-term impact on lung health in South African children with presumptive pulmonary TB—a study protocol

Cited by 6 publications

References 53 publications

Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis

Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis

Urinary markers of Mycobacterium tuberculosis and dysbiosis in paediatric tuberculous meningitis cases undergoing treatment

Pulmonary Function Outcomes after Tuberculosis treatment in Children: A Systematic Review and Meta-analysis

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