A propósito de un caso pediátrico de tuberculosis oftálmica y drogorresistencia / Presentation of a Pediatric Case of Ocular Tuberculosis and Drug Resistance

El compromiso ocular es una forma extrapulmonar de tuberculosis. Puede comprometer cualquier componente del sistema visual. Las manifestaciones oculares pueden ser causadas por una infección activa que invade el ojo o por una reacción inmunológica de hipersensibilidad retardada. Las presentaciones clínicas más comunes son uveítis anterior crónica, coroiditis y esclero-queratitis. A pesar de la existencia de herramientas moleculares altamente sensibles, arribar al diagnóstico de formas poco frecuentes o no pensadas como la TB ocular en un niño sigue siendo un gran reto y se basa en la presentación clínica, evaluación sistémica y la respuesta terapéutica. El tratamiento implica el uso de antifímicos y, muchas veces, esteroides. El objetivo fue presentar una forma de tuberculosis endoftálmica, pulmonar miliar y meníngea, en el marco de la drogorresistencia.

Eye engagement is an extrapulmonary form of tuberculosis. It can compromise any component of the visual system. Eye manifestations can be caused by an active infection that invades the eye or by a delayed hypersensitivity immune reaction. The most com mon clinical presentations are: chronic anterior uveitis, choroiditis and sclero-keratitis. Despite the existence of highly sensitive molecular tools, arriving at diagnosis in rare or undeceived ways with eye tuberculosis in a child remains a major challenge, based on clinical presentation, systemic evaluation and therapeutic response. Treatment involves the use of antiphymics and often steroids. The objective was to present a form of endophthalmic tuberculosis, miliary pulmonary and meningeal, in the framework of drug resistance.

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

uberculosis (TB) remains the world's deadliest infectious disease that affects a third of the world's population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children's inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Rapid detection of Mycobacterium tuberculosis in children using blood and urine specimens

Abstract INTRODUCTION: Laboratory and clinical features of childhood tuberculosis (TB) are non-specific and establishing an accurate diagnosis remains a challenge. This study evaluated a Single tube nested-PCR (STNPCR) to detect genomic DNA of Mycobacterium tuberculosis complex in blood and urine. METHODS: Biological samples were obtained from children (<15 years old) with clinical suspicion of pulmonary and extrapulmonary TB at public hospitals in Recife-Pernambuco, Brazil. Cultures yielded negative results in a majority of childhood TB cases, which are generally paucibacillary. A set of clinical, epidemiological, radiological, and laboratory criteria with evident clinical improvement after anti-TB treatment were frequently used to define childhood TB cases. RESULTS: Ninety children with clinical suspicion were enrolled in this study (44 with TB and 46 without TB). The pulmonary TB group had 20 confirmed cases and 46 negative controls, while the extrapulmonary TB group had 24 confirmed cases. The STNPCR showed sensitivities to pulmonary and extrapulmonary TB of 47.4% and 52.2% (blood) and 38.8% and 20% (urine), respectively. Considering the low performance of STNPCR on separate samples, we decided to perform a combined analysis (parallel sensitivity analysis) of the results from blood and urine samples. The parallel sensitivity increased to 65% in blood and 62.5% in urine. The specificity in both samples ranged from 93.5-97.8%. CONCLUSIONS: Although STNPCR showed moderate sensitivity, the specificity is high; therefore, the test can be used as an auxiliary tool to diagnose TB in children. It is a rapid test that demonstrated better performance than other diagnostic tests in paucibacillary samples as it does in childhood tuberculosis.

​Interpretation And Clinical Correlation Of Tuberculin Skin Test Results Among Clinically Diagnosed Childhood Tuberculosis

Background: Diagnosing tuberculosis (TB) was still a worldwide big challenge in cases with negative reports of Xpert MTB/RIF, smear, and culture test of acid-fast bacilli (AFB). A single, direct Xpert MTB/RIF test identified 98.2% of the sputum smearpositive TB cases and 72.5% of those with sputum smear-negative TB. Such a diagnosis was often made based on the clinicalcriteria and other supportive findings like tuberculin skin test (TST).Objective: Hence, this study was to help in the diagnosis and treatment of clinically diagnosed childhood TB, especially in thelimited resource rural areas and developing countries.Materials and Methods: Based on the WHO revised criteria of TB diagnosis, to include clinically diagnosed TB instead ofsmear-negative TB disease, an operational definition of clinically diagnosed TB for the selection of participants for TST wasestablished for this study. Based on the recommendation of the CDC team at the Saskatchewan Lung Association, 2007-03-21at the Wayback Machine, the TST results of the study were interpreted.Results: Hence, in our study, the sensitivity of TST was 82.35% (≥10 mm) in the age group of 1–4 years and 60.16% (≥15 mm)in the age group of >4–12 years. However, this study shows that the positivity rate of TST was increased from 60.16% (≥15 mm)to 86.15% (≥10 mm), if the TST results≥10 mm were interpreted as positive even in this age group of >4 years–12 years.Conclusion: In such very difficult situations of clinically diagnosed TB, this study observed that empiric anti-TB treatment may bestarted without microbiological confirmation to clinically diagnosed childhood TB patient with negative reports of Xpert MTB/RIF,smear, and culture test of AFB, presented with one or more of the following symptoms and signs of clinically diagnosed childhoodTB: (1) Chronic anorexia, (2) ill health and fatigue, (3) weight loss of >5% during the past 3 months or documented failure to striveduring the preceding 3 months, (4) night sweating and persistent fever >2 weeks, and (5) non-remitting cough >2 weeks but cannot bediagnosed clinically by any possible causes than TB, and positive TST report, in resource-limited rural areas anddeveloping countries.

Association of factors with successful treatment outcome of childhood tuberculosis in Barangay Commonwealth, Quezon City, Philippines: A two-year retrospective study

Background@#Tuberculosis remains a public health concern worldwide. Reports on the association of factors of childhood tuberculosis with treatment outcome are limited. @*Objectives@#To determine the epidemiology and association of factors of childhood tuberculosis with successful treatment outcome in some of the barangays of Quezon City. @*Methodology@#This is a retrospective cohort study done at Barangay Commonwealth Health Centers including children 0-14 years old with tuberculosis registered and treated from January 1, 2013 to July 15, 2015. Socio-demographic and clinical data were obtained. Patient profile data, treatment cards and medical records were the data sources @*Results@#A total of 267 new cases of childhood TB were analyzed. The treatment success rate was 98% (97% completed treatment, 1% cured). The rate of poor treatment outcome including default cases was 2%. There were no reported deaths or treatment failure. On univariate analysis, patients with weight gain (p=0.001) had an odds ratio of 8.085 (95% CI:1.310-49.900) to have a successful treatment outcome. On multivariate analysis, weight gain was significantly associated with treatment success (p=0.042; OR=12.5, 95% CI: 1.091, 143.244). None of the socio-economic and clinical factors studied was associated with successful treatment outcome. @*Conclusion@#Weight gain is a factor of a successful treatment in childhood tuberculosis. Children who gained weight after treatment are more likely to have a successful treatment outcome.

Tuberculosis infantil: estudio de tendencia en la Región Sanitaria V de la provincia de Buenos Aires, años 2000-2014 / Childhood tuberculosis: A trend analysis in Public Health Region V of the Province of Buenos Aires, 2000-2014

La prevención, el diagnóstico y el tratamiento de la Tuberculosis Infantil (TBI), no ha sido suficientemente reconocida como causa importante de enfermedad y muerte entre los 0 a 14 años. El objetivo del presente trabajo fue analizar la situación epidemiológica de la TBI en la Región Sanitaria V (RSV), provincia de Buenos Aires. Es un estudio observacional longitudinal, realizado entre el 1º de enero del 2000 y el 31 de diciembre de 2014. Se efectuó un análisis de tendencia sobre un total de 2.142 casos de Tuberculosis Infantil, calculada por regresión lineal simple y expresada como variación anual promedio (VAP). Se analizó el número de casos notificados y tasas de incidencia(TI) por 100.000 habitantes de todas las formas de TBI, TBI pulmonar (TBIP) y TBIP confirmada por bacteriología. La TBP se estudió desagregada en dos grupos de edad: 0 a 4 y 5 a 14 años. Resultados: La tasa de incidencia de TBI y la tasa de incidencia de la TBIP presentaron una tendencia neta al descenso, con una declinación mayor al 5% y similar a la TBIP entre los 0 a 4 años y entre los 5 a 14 años. En cambio, la tasa de incidencia de la TBIP confirmada del total de los casos y en los dos subgrupos, la tendencia al descenso fue mínima y no resultó estadísticamente significativa. La TB se mantiene como un riesgo de salud en la RSV, con la mayor afectación en edades jóvenes, hecho que refleja la tendencia de una transmisión reciente y que se asocia cuando no se ha logrado controlar la enfermedad (AU)

Prevention, diagnosis, and treatment of childhood tuberculosis (childhood TB) is underrecognized as an important cause of disease and death between 0 and 14 years of age. The aim of this study was to analyze the epidemiological situation of childhood TB in the Public Health Region V (PHRV), the province of Buenos Aires. In a longitudinal, observational study conducted between January 1, 2000 and December, 2014.A trend analysis was performed in a total of 2,142 cases of childhood TB, calculated by simple linear regression and expressed as average annual rate (AAR). The number of reported cases and incidence rate (IR) were calculated per 100,000 inhabitants of all forms of childhood TB, childhood lung TB, and childhood lung TB confirmed by bacteriological tests. Lung TB was assessed according to age group: 0 to 4 and 5 to 14 years. Results: IR of childhood TB and IR of childhood lung TB showed a net downward trend, with a greater than 5% decrease and similar to childhood lung TB between children between 0 and 4 years and those between 5 and 14 years of age. However, the IR of confirmed childhood lung TB of the total of cases and in the two subgroups showed a minimal downward trend and was not statistically significant. TB remains a health risk in PHRV, with a higher incidence in children, reflecting a trend of recent transmission and associated with a lack of disease control (AU)

Control de foco de tuberculosis en menores de 15 años / Control of tuberculosis focus in under 15 years-old children

INTRODUCCIÓN: los niños se infectan de tuberculosis a partir del contacto con un adulto enfermo, casi siempre en el hogar. OBJETIVO: evaluar la calidad de las acciones de control de foco en niños expuestos. MÉTODOS: estudio retrospectivo, descriptivo de los controles de focos de tuberculosis realizados a 143 menores de 15 años que estuvieron en contacto con 95 enfermos, en el municipio habanero de "10 de Octubre". Se clasificaron en 3 categorías: 1) expuestos: niños sin elementos clínicos, radiológicos ni microbiológicos de enfermedad activa y anergia tuberculínica; 2) con infección latente: niños reactores a la tuberculina (lecturas de 5 o más mm), pero sin elementos de enfermedad activa; y 3) enfermos: niños con criterios clínicos y/o radiológicos de tuberculosis activa, independientemente del resultado de la prueba de Mantoux y los estudios microbiológicos. RESULTADOS: se estudió una media de 1,5 menores de 15 años por cada caso índice, con una edad media de 6,7 años, con predominio de los prescolares (63= 44,1 %) y el sexo masculino (87= 60,8 %). La mayoría se consideraron expuestos (124= 86,9 %); la cuarta parte de los niños con exposición intradomiciliaria se infectaron o enfermaron (16/62= 25,8 %), resultado muy superior a la extradomiciliaria (3/81= 3,7 %). Se diagnosticaron 3 enfermos: 2 formas pulmonares primarias, y una adenitis (entre 1 y 5 años), que representan el 60 % de los casos infantiles diagnosticados en el municipio en ese quinquenio. Se identificaron errores: no registro de la quimioprofilaxis primaria (55= 38,4 %), inicio tardío del control de foco (39= 27,3 %), y la no realización de la prueba de Mantoux o radiografía torácica al inicio (24= 16,7 %), entre otros. CONCLUSIONES: es necesario fortalecer la capacitación del personal de salud y el cumplimiento de los procedimientos establecidos en el Programa, para garantizar la calidad de los controles de foco, y contribuir a la eliminación de la tuberculosis como problema de salud.

INTRODUCTION: the children become infected with tuberculosis from contact with sick adults, most often at home. OBJECTIVE: to evaluate the quality of tuberculosis foci control actions in exposed children. METHODS: retrospective and descriptive study of tuberculosis foci control actions conducted in 143 children aged less than 15 years, who had been in contact with 95 sick persons in 10 de Octubre municipality in Havana. They were classified into 3 categories: 1) exposed: children with no clinical, radiological or microbiological elements of active disease and tuberculin anergy; 2) latent infective: children reacting to tuberculin (5 mm or more readings), but with no active disease elements, and 3) ill: children with clinical and/or radiological criteria of active tuberculosis regardless of the Mantoux's test results and the microbiological studies. RESULTS: a mean of 1.5 children under 15 years of age per index case, average age of 6.7 years, predominating preschoolers (63= 44.1 %) and males (87= 60.8 %). Most of them were considered exposed (124= 86.9 %); a quarter of the children exposed at home became infected or sick (16 out of 62= 25.8 %), and this result was much higher than the outdoor exposure (3 out of 81= 3.7 %). Three sick children were diagnosed-two had primary pulmonary forms and one had adenitis (one to 5 years-old). They accounted for 60% of the pediatric cases diagnosed in the municipality in this 5-year period. The identified errors were non-registration of primary chemoprophylaxis (55= 38.4%), late starting of focus control (39= 27.3 %) and non-performance of Mantoux's test or thorax X-ray at the very beginning (24= 16.7 %) among others. CONCLUSIONS: it is necessary to strengthen the training of the health staff and the compliance with the procedures set by the National Program, in order to assure the quality of focus controls and to contribute to the eradication of tuberculosis as a health problem.

Characteristics of childhood tuberculosis patients registered under RNTCP in Varanasi, Uttar Pradesh.

Childhood tuberculosis (TB) reflects on-going transmission. Data on childhood TB from TB registers under Revised National Tuberculosis Control Program of 2008 and 2009 in Varanasi district was analyzed. Proportion of childhood TB was 8.3% of total registered cases 12,242. It was lower than estimated 10-20% in endemic areas. In rural Tuberculosis Units childhood case detection was poor. Case detection in ≤5 years was very less. The childhood cases were detected mainly in adolescent age group. Thus, childhood TB is remaining a under diagnosed/under reported disease in India. It needs attention to increase the detection of childhood TB cases to control TB in general population.

Comportamiento de la tuberculosis en adolescentes de 15 a 18 años / Situation of tuberculosis in 15 to 18 years-old adolescents

Introducción: la adolescencia constituye una edad de riesgo para la tuberculosis. Objetivo: caracterizar la tuberculosis en adolescentes de entre 15 y 18 años en La Habana, en el período 2001-2010. Métodos: se realizó un estudio observacional, descriptivo y transversal, en el universo de adolescentes de 15 a 18 años afectados de tuberculosis, de la provincia La Habana, desde el 1º de enero de 2001 hasta el 31 de diciembre de 2010. De las encuestas epidemiológicas se revisaron: variables demográficas, categoría epidemiológica, topografía de la lesión, estudios realizados y resultados del tratamiento. Resultados: se reportó una incidencia de 32 casos, con 8 casos en 2001 y 6 en 2010, y tasas de 8,6 y 4,9 × 100 mil habitantes de 15-18 años respectivamente. Predominó el sexo masculino y la edad de 18 años, sin relación con el color de la piel. Los municipios más afectados fueron 10 de Octubre, Habana Vieja y Centro Habana. Predominaron los estudiantes (17-53,1 %), de ellos 5 en escuelas internas; 9 eran desocupados (28,1 %), incluyendo 1 recluso. En la mayoría (20 casos, 62 %) no se encontró el contacto infectante. Predominó la forma pulmonar (27-84,4 %), con 44,4 % de baciloscopias positivas. No se reportó coinfección con el virus de la inmunodeficiencia humana. Todos recibieron el tratamiento estrictamente supervisado y curaron, con excepción de un fallecido en la segunda semana de tratamiento. Conclusiones: es necesario profundizar en los factores que inciden en la tuberculosis en este grupo de edad, así como garantizar un mayor aislamiento microbiológico y búsqueda exhaustiva de la fuente de infección.

Introduction: adolescence is a risky age for tuberculosis. Objective: to characterize tuberculosis in 15-16 years old adolescents in Havana from 2001-2010. Methods: a cross-sectional, observational and descriptive study was conducted in a universe of 15-18 years-old adolescents with tuberculosis from Havana in the period of January 1st, 2001 to December 31st, 2010. Demographic variables, epidemiological category, lesion topography, performed studies and treatment results were reviewed in the epidemiological surveys. Results: there was reported an incidence of 32 cases, with 8 and 6 cases in 2001 and 2010 respectively and rates of 8.6 and 4.9 per one hundred thousand 15-18 years old respectively. Males and age of 18 years prevailed, no association with race. The most affected municipalities were 10 de Octubre, Habana Vieja y Centro Habana. The students predominated (17-53.1 %), 5 of them in boarding schools; 9 were unemployed (28.1 %) including 1 prisoner. The infecting contact was not found in most of the cases (20 cases, 62 %). Pulmonary form predominated (27 cases-84.4 %) showing 44.4% of positive bacilloscopy. There was no co-infection with human immunodeficiency virus. All the patients received the strictly supervised treatment and they recovered, except for one death during the second week of treatment. Conclusions: it is necessary to delve into the factors having an effect on tuberculosis within this age group, as well as to assure more microbiological isolation and extensive search for the source of infection.

Passive smoking, Indoor air pollution and Childhood tuberculosis: A case control study.

Background: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children’s respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. Aims: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. Methods: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. Results: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. Conclusion: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services.

Description of Pediatric Tuberculosis Evaluated in a Referral Center in Istanbul Turkey

PURPOSE: Diagnosis of tuberculosis (TB) in children is more challenging than in adults. This study aimed to describe demographical, clinical and laboratory findings of children diagnosed with tuberculosis in Turkey, including the issues of contact tracing, culture positivity and forms of the disease. MATERIALS AND METHODS: Clinical and laboratory data of 51 children with a mean age of 8.0+/-4.6 years who were diagnosed with TB were retrospectively reviewed. Main diagnostic tools included tuberculin skin test, chest X-ray, sputum/gastric aspirate culture with sensitivity testing, and direct microscopy for acid-fast bacilli on available samples. Clinical characteristics and outcomes of the patients were examined. RESULTS: Thirty-six (70.6%) children were diagnosed with intra-thoracic and 15 (29.4%) with extra-thoracic tuberculosis. Twenty-eight of the patients had a positive Bacillus Calmette-Guerin vaccine scar (28/51, 54.9%) and 23/51 (45.1%) had a positive tuberculin skin test. An adult TB contact was identified in 27 (52.9%) of the cases. On direct microscopy, acid-fast bacilli were found in nine (17.6%) patients and positive culture for Mycobacterium tuberculosis was found in 19 (37.3%). Drug resistance to isoniazid was detected in four (7.8%). One patient with nephrotic syndrome and miliary tuberculosis died during follow-up. All other patients responded well to the treatment. CONCLUSION: Focusing on active contact tracing among all household contacts of tuberculous cases may be helpful in early identification and controlling childhood disease, even in regions with low disease prevalence. Adopting a suspicious and proactive approach in this particular age group is warranted.

Prevention of childhood tuberculosis / 国际儿科学杂志

In recent years the incidence rate of tuberculosis (TB) has gone up.It was estimated that 1/3of people had asymptomatic latent tuberculosis infection globally.The current widespread use of Bacillus calmetteguerin (BCG) vaccine program against tuberculosis in children has a good preventive effect,but due to the limited duration of the immune responses induced by BCG,there also had situation of prevent failure,so researchers begin to explore new TB vaccines,such as live attenuated mutant strains,subunit vaccines and DNA vaccines,and achieved certain results.For the pure protein derivative tuberculosis skin test positive and immunosuppressed children,in addition to active immunization would also need anti-TB medicine for chemoprophylaxis.

Análise espacial da tuberculose infantil no estado do Espírito Santo, 2000 a 2007 / Spatial analysis on childhood tuberculosis in the state of Espirito Santo, Brazil, 2000 to 2007

INTRODUÇÃO: A tuberculose infantil é responsável por 15 por cento das notificações dos casos. O foco do Programa Nacional de Controle da Tuberculose é a identificação da tuberculose em adultos, deixando os menores de 15 anos à margem dos estudos, diagnóstico e tratamento. A análise espacial quantifica a exposição à doença e expõe as principais causas relacionadas ao espaço geográfico. O objetivo deste estudo é analisar a distribuição espacial da tuberculose infantil no Espírito Santo, de 2000 a 2007, segundo município de notificação MÉTODOS: Realizou-se um estudo ecológico dos 515 casos de tuberculose infantil, entre 2000 e 2007. Utilizou-se o Método Bayesiano Empírico Local para estimação do risco. O Índice de Moram Local foi calculado para avaliação da autocorrelação entre as incidências de bairros limítrofes RESULTADOS: Altas taxas de incidência foram encontradas na Região Metropolitana de Vitória e região nordeste, e baixas taxas na região serrana; dados semelhantes foram observados no estudo da endemia de tuberculose em adultos no Espírito Santo, o que pode possivelmente estar relacionada aos contatos intradomiciliares CONCLUSÕES: Este estudo identifica possíveis áreas de transmissão recente da doença. É importante ressaltar que o conhecimento dos locais prioritários para o controle, pode auxiliar a gestão publica na diminuição das iniquidades em saúde e permitir uma otimização dos recursos e das equipes no controle da tuberculose infantil.

INTRODUCTION: Childhood tuberculosis is responsible for 15 percent of case notifications. The focus of Tuberculosis Control National Program is on identifying tuberculosis in adults, while leaving children under 15 years of age on the margins of studies, diagnoses and treatment. Spatial analysis quantifies the exposition to the illness and displays the main causes relating to geographical space. The objective of this study was to analyze the spatial distribution of childhood tuberculosis in Espírito Santo, between 2000 and 2007, according to the municipality of notification METHODS: An ecological study was conducted on 515 cases of childhood tuberculosis that occurred between 2000 and 2007. The Local Empirical Bayesian Method was used to measure the risk. The Moran Local Index was calculated in order to evaluate autocorrelations between threshold districts RESULTS: High incidence rates were found in the Metropolitan Region of Vitória and the northeastern region, and lower rates were found in the southeastern region. Similar data were observed in a study on endemic tuberculosis among adults in Espírito Santo. This is possibly related to contacts within the home CONCLUSIONS: This study identified possible areas of recent transmission of the disease. It is important to emphasize that knowledge of the high priority areas for tuberculosis control may help public administrators to diminish healthcare iniquities and enable improvement of resources and teams for controlling childhood tuberculosis.

Clinical profile and treatment outcome of Tuberculous Lymphadenitis in children using DOTS strategy.

Background: Extra pulmonary TB (EPTB) including tuberculous lymphadenitis is becoming more common probably due to human immuno deficiency virus (HIV) co-infection. While children do experience a high TB related morbidity and mortality, management of TB in children is challenging. The present study was designed to study the treatment outcome of DOTS strategy for pediatric tuberculous lymphadenitis. Objective: To study the efficacy of DOTS strategy for pediatric lymphhnode tuberculosis. Methods: Retrospective analysis of 669 children of lymphnode tuberculosis treated with DOTS strategy over 9½ years. Results: Mean age was 9.8 years with significantly more girls (61.3%) than boys (38.7%) {c2=34.08, P< 0.001 (S)}. Most of the patients were in the age group of 11-14 years (48.0%) followed by 6-10 years(34.5%) and 0-5 years(17.5%) respectively. Cervical tuberculous lymphadenitis (88.2%) was the commonest form for all ages followed by axillary lymphadenitis in 3.3%. TB of other sites was seen in only 57 (8.5%) cases. Out of total 622 (93%) cases of lymphnode TB where fine needle aspiration and/ or excisional biopsy was done, it was positive (84.2%) and negative (15.6%) respectively for AFB/ cytology, while it could not be done in 47 patients due to inaccessible sites. Category I, II and III was started on 15.4%, 7.5% and 77.1% patients respectively. Overall, treatment completion rate was 94.9% and the default rate was 2.2% with a failure rate of 2.5%. Death rate was 0.3%. Conclusion: The study confirms the efficacy of DOTS strategy for pediatric TB lymphadenitis

Intermittent Short Course Therapy for Pediatric Tuberculosis.

We conducted this study to assess the efficacy of intermittent short course therapy in all forms of pediatric tuberculosis using a coordinated approach with Revised National Tuberculosis Control Programme (RNTCP). Sixty-five children were treated using RNTCP protocols with some modifications, such as dose adjustments or prolongation of treatment in selected children. Overall response rate was 95% (pulmonary 94% and extra pulmonary 97%). There was one case with possible relapse. With dynamic inputs from both the treating pediatrician and personnel from Directly Observed Treatment – Short-course (DOTS) centers, we could successfully implement RNTCP protocols in childhood tuberculosis.

Clinical Review of Tuberculosis in Childhood

No abstract available.