Paediatric tuberculosis – new advances to close persistent gaps

Marais, Ben J. and Verkuijl, Sabine and Casenghi, Martina and Triasih, Rina and Hesseling, Anneke C. and Mandalakas, Anna M. and Marcy, Olivier and Seddon, James A. and Graham, Stephen M. and Amanullah, Farhana (2021) Paediatric tuberculosis – new advances to close persistent gaps. International Journal of Infectious Diseases, 113. S63 – S67. ISSN 12019712

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Abstract

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. © 2021 The Author(s)

Item Type: Article
Additional Information: Cited by: 20; All Open Access, Gold Open Access
Uncontrolled Keywords: Adult; Child; Child, Preschool; HIV Seropositivity; Humans; Overtreatment; Tuberculosis; isoniazid; lipoarabinomannan; rifampicin; rifapentine; tuberculostatic agent; Article; assay; case finding; child; child health care; childhood disease; computer assisted tomography; diagnostic accuracy; diagnostic imaging; diagnostic test accuracy study; drug resistant tuberculosis; evidence based practice; fear; health care access; high risk population; household; human; Human immunodeficiency virus infected patient; malnutrition; nuclear magnetic resonance imaging; point of care ultrasound; positron emission tomography; practice gap; preventive health service; screening test; thorax radiography; tuberculosis; urinalysis; vulnerable population; World Health Organization; adult; Human immunodeficiency virus infection; preschool child; tuberculosis
Subjects: R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine, Public Health and Nursing > Biomedical Sciences
Depositing User: Sri JUNANDI
Date Deposited: 27 Sep 2024 06:03
Last Modified: 27 Sep 2024 06:03
URI: https://ir.lib.ugm.ac.id/id/eprint/4525

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