-
[show abstract]
[hide abstract]
ABSTRACT: The management of children with drug-resistant (DR) tuberculosis (TB) is challenging and it is likely that in many places the roll-out of molecular diagnostic testing will lead to more children being diagnosed. There is a limited evidence base to guide optimal treatment and follow-up in the pediatric population; in existing DR-TB guidelines the management of children is often relegated to small 'special populations' sections. This article seeks to address this gap by providing clinicians with practical advice and guidance. This is achieved through review of the available literature on pediatric DR-TB, including research studies and international guidelines, combined with consensus opinion from a team of experts who have extensive experience in the management of children with DR-TB in a wide variety of contexts and with varying resources. The review covers treatment initiation, regimen design and treatment duration, management of co-morbid conditions, treatment monitoring, adverse events, adherence promotion, and infection control, all within a multidisciplinary environment.
American Journal of Respiratory and Critical Care Medicine 09/2012; · 11.08 Impact Factor
-
Luis E Cuevas,
Renee Browning,
Patrick Bossuyt,
Martina Casenghi,
Mark F Cotton,
Andrea T Cruz,
Lori E Dodd,
Francis Drobniewski, Marianne Gale,
Stephen M Graham, [......],
Richard Oberhelman,
Paul Palumbo,
Estelle Russek-Cohen,
David E Shapiro,
Betsy Smith,
Giselle Soto-Castellares,
Jeffrey R Starke,
Soumya Swaminathan,
Claire Wingfield,
Carol Worrell
[show abstract]
[hide abstract]
ABSTRACT: Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children. In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children.
The Journal of Infectious Diseases 04/2012; 205 Suppl 2:S209-15. · 6.41 Impact Factor
-
Stephen M Graham,
Tahmeed Ahmed,
Farhana Amanullah,
Renee Browning,
Vicky Cardenas,
Martina Casenghi,
Luis E Cuevas, Marianne Gale,
Robert P Gie,
Malgosia Grzemska, [......],
Surbhi Modi,
Lynne Mofenson,
Philippa Musoke,
Sharon Nachman,
Clydette Powell,
Mona Rigaud,
Vanessa Rouzier,
Jeffrey R Starke,
Soumya Swaminathan,
Claire Wingfield
[show abstract]
[hide abstract]
ABSTRACT: There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.
The Journal of Infectious Diseases 03/2012; 205 Suppl 2:S199-208. · 6.41 Impact Factor
