Paediatric tuberculosis – new advances to close persistent gaps

International Journal of Infectious Diseases

Sabine Verkuijl¹  Farhana Amanullah²  Anneke C. Hesseling³  Stephen M. Graham⁴  Anna M. Mandalakas⁴  Rina Triasih⁵  Martina Casenghi⁶  Olivier Marcy⁷  Ben J. Marais⁸  James A. Seddon⁹ 

[1] Corresponding author at: Clinical School, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, 2145, Sydney, Australia.;Department of Infectious Diseases, Imperial College London, London, United Kingdom;Department of Paediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada and Dr. Sardjito Hospital, Yogyakarta, Indonesia;Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa;Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland;Global TB Programme, World Health Organisation (WHO), Geneva, Switzerland;Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, United States;The Children’s Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia;University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France;

关键词: child;    childhood;    tuberculosis;    prevention;    case finding;    gap;   

DOI  :  

来源: DOAJ

【 摘 要 】

Young children are most vulnerable to develop severe forms of tuberculosis (TB) and are over-represented among TB deaths. Almost all children estimated to have died from TB were never diagnosed or offered TB treatment.Improved access to TB preventive treatment (TPT) requires major upscaling of household contact investigation with allocation of adequate resources. Symptom-based screening is often discouraged in adults for fear of generating drug resistance, if TB cases are missed. However, the situation in vulnerable young children is different, as they present minimal risk of drug resistance generation. Further, the perceived need for additional diagnostic evaluation presents a major barrier to TPT access and underlies general reluctance to consider pragmatic decentralised models of care.Widespread roll-out of Xpert MTB/RIF Ultra® represents an opportunity for improved case detection in young children, but attaining full impact will require the use of non-sputum specimens. The new Fujifilm SILVAMP TB LAM® urine assay demonstrated good diagnostic accuracy in HIV-positive and malnourished children, but further validation is required. Given the limited accuracy of all available tests and the excellent tolerance of TB drugs in children, the global community may have to accept some over-treatment if we want to close the persistent case detection gap in young children.

【 授权许可】

Unknown