Pediatric Tuberculosis at Beijing Children's Hospital: 2002-2010
Capital Medical University, Peping, Beijing, China PEDIATRICS
(Impact Factor: 5.47).
11/2012; 130(6). DOI: 10.1542/peds.2011-3742
Our aim was to describe the patient characteristics, clinical-epidemiological profile, and treatment outcome of childhood tuberculosis (TB).
A retrospective, descriptive study was undertaken of 1212 children aged 0 to 18 years admitted to Beijing Children's Hospital for the treatment of TB from January 2002 to December 2010. Statistical significance of category variables was evaluated by using Fisher's exact test.
Fifty-four percent of patients had extrapulmonary tuberculosis (EPTB), 38.8% had tuberculous meningitis, and 31.3% had disseminated TB. The last 2 types were defined as severe TB. Most patients with TB (81.6%) were cured or completed treatment. There were more patients aged <5 years and from rural areas with EPTB than with pulmonary tuberculosis. More severe cases of TB were found in patients aged <1 year than other less severe types of TB. Patients with no bacille Calmette-Guérin vaccination and a contact history at home had a significantly risk of contracting severe TB. Children aged <1 year and those with severe TB were more likely to have poor treatment outcomes (failed to improve or died). Among those with EPTB, only 61.3% and 61.1% had positive results on the purified protein derivative tuberculin skin test and chest radiograph, respectively.
In this referral hospital setting, more pediatric EPTB and severe TB patients were found among children aged <1 year. Age <1 year and having severe TB were risk factors for treatment failure. Thus, prevention and health care in pediatric TB should focus on both EPTB and severe TB.
Available from: PubMed Central
- "Generally in developing countries, the low 10%–15% positive rate of the AFB microscopy in pediatric TB cases is accompanied by very low sensitivity of the MTB culture, since 20% to 80% of children who suffered from TB do not have positive MTB culture results . And a retrospective study of pediatric TB cases in hospital also found the positive rate of AFB microscopy or MTB culture (either one was positive) was only 9.7% . That suggests just using AFB microscopy and MTB culture to confirm childhood PTB is not nearly enough. "
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ABSTRACT: In order to evaluate the diagnostic accuracy of the Xpert MTB/RIF assay on childhood pulmonary tuberculosis (PTB) using bronchoalveolar lavage fluid (BALF), we evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of Xpert MTB/RIF assay using BALF in comparison with acid-fast bacilli (AFB) microscopy and Mycobacterium tuberculosis (MTB) culture for diagnosing childhood PTB using Chinese "composite clinical reference standard" (CCRS) as reference standard. Two hundred fifty-five children with suspected PTB were enrolled at Beijing Children's Hospital from September 2010 to July 2013. Compared with Chinese CCRS, the sensitivity of AFB microscopy, MTB culture, and Xpert MTB/RIF assay was 8.4%, 28.9%, and 53.0%, respectively. The specificity of three assays was all 100%. Xpert MTB/RIF assay could detect 33.9% of cases with negative MTB culture, and 48.7% of cases with negative AFB microscopy. Younger age (<3 years), absence of BCG scar, and contact with TB patient were found significantly associated with a positive result of Xpert MTB/RIF assay. In conclusion, Xpert MTB/RIF assay using BALF can assist in diagnosing childhood PTB much faster when fiberoptic bronchoscopy is necessary according to the chest radiograph.
BioMed Research International 04/2014; 2014:310194. DOI:10.1155/2014/310194 · 1.58 Impact Factor
Available from: Anna Mandalakas
PEDIATRICS 11/2012; 130(6). DOI:10.1542/peds.2012-2832 · 5.47 Impact Factor
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ABSTRACT: In most high-income countries, fewer children now acquire meningitis, and many of those who do will survive. Globally, however, meningitis still remains a significant cause of child morbidity and mortality. In this article, the authors review recent evidence on the morbidity faced by childhood survivors of bacterial meningitis. Outcomes vary by bacterial pathogen, with around a 20 % risk for severe sequelae (most commonly, neurocognitive) by all pathogenic causes. Pneumococcal, tuberculosis, and group B streptococcal meningitis lead to the highest rates of sequelae. Recent epidemiological shifts in the major pathogens causing meningitis, as well as varied regional settings between studies, limit generalizability of evidence in the literature, and better research using longitudinal data and case-control methodology is required, especially in low-income countries. However, the consistently high levels of complications described in the literature call for more widespread vaccination programs for prevention and a greater focus on potential complications by educators and health-care providers to support childhood survivors of bacterial meningitis and their families.
Current Infectious Disease Reports 03/2013; 15(3). DOI:10.1007/s11908-013-0332-6 · 1.68 Impact Factor
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