Childhood tuberculosis and its diagnosis in Argentina

Fil: Miceli, Isabel N. P. Hospital Prof. Dr. A. Posadas. Sector Epidemiología; Argentina.Fil: Sequeira, Maria Delfina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni; Argentina.Fil: de Kantor, Isabel N. Organización Mundial de la Salud. Cuadro de Consultores en Tuberculosis; Argentina.La incidencia de tuberculosis (TBC) en menores de 5 años en Argentina fue 24.3/ 100.000 habitantes en el año 2000, y la tasa global 31.8/ 100.000. Un 17% de los casos fueron menores de 15 años, lo que indica una activa transmisión de la infección, que se diagnostica generalmente ya con enfermedad avanzada, por la historia de foco, la reacción tuberculínica positiva, y los signos y síntomas clínico- radiológicos. El aporte de la bacteriología al diagnóstico es escaso, empleándose en 0-4 años el aspirado o lavado gástrico. Para el cultivo se usan los medios sólidos a base de huevo o, en laboratorios de referencia, los de detección temprana. Las pruebas de amplificación de ácidos nucleicos están disponibles en algunos laboratorios, pero sin un sistema de garantía de calidad; sus resultados deben considerarse sólo dentro del contexto clínico. El fortalecimiento de la red de laboratorios de cultivo facilitará el diagnóstico de certeza de la TBC infantil, la confiabilidad de la notificación, y el conocimiento de la resistencia bacteriana. Para revertir la actual situación epidemiológica es necesario incrementar la investigación de los niños contactos de casos bacilíferos, seguida de quimioprofilaxis o tratamiento según corresponda. La meningitis TBC en menores de 5 años tuvo una disminución significativamente mayor que la de la TBC en adultos, en los últimos 20 años en Argentina. En 2000 se notificaron sólo 10 casos de meningitis en esas edades (0.29/ 100.000). Esto confirma la protección conferida por la vacunación BCG al nacimiento, con alta y continuada cobertura. (EN) TB notification rate in infants and children 0-4 years was 24.3/ 100.000 in Argentina, in 2000, for a global incidence of 31.8/ 100.000. A 17% of all TB cases occurred in children (0-14 years), indicating a very active TB transmission. Usually TB is diagnosed when the disease is already advanced. Main criteria for the diagnosis are: a previous contact with an infectious TB patient, a positive PPD test result and clinical - radiological signs and symptoms. Bacteriology plays a limited role in diagnosis; gastric aspirate is the most often used specimen for bacteriological examination in children. Culture is performed on solid egg-media, but other more recently developed culture media systems are available in reference laboratories. Nucleic acid amplification assays are also used, but its systematic quality control is still lacking. Their results should be considered only as complementary. Strengthening of the laboratory network will contribute to increase diagnostic certainty of childhood TB, to improve reliability of cases reported, and to a better knowledge of the drug resistance profile. Early diagnosis of TB in children, by contacts investigation of infectious patients, followed by preventive chemotherapy or treatment when necessary, may revert the current epidemiological situation. TB meningitis in the 0-4 years group showed a significantly more pronounced decline than that of adults TB for the period 1980-2000, (only 10 meningitis cases were diagnosed in year 2000, 0.29/ 100.000), confirming the protection conferred by BCG vaccination when applied to newborns with a continuously high coverage

Childhood tuberculosis and its diagnosis in Argentina

Fil: Miceli, Isabel N. P. Hospital Prof. Dr. A. Posadas. Sector Epidemiología; Argentina.Fil: Sequeira, Maria Delfina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni; Argentina.Fil: de Kantor, Isabel N. Organización Mundial de la Salud. Cuadro de Consultores en Tuberculosis; Argentina.La incidencia de tuberculosis (TBC) en menores de 5 años en Argentina fue 24.3/ 100.000 habitantes en el año 2000, y la tasa global 31.8/ 100.000. Un 17% de los casos fueron menores de 15 años, lo que indica una activa transmisión de la infección, que se diagnostica generalmente ya con enfermedad avanzada, por la historia de foco, la reacción tuberculínica positiva, y los signos y síntomas clínico- radiológicos. El aporte de la bacteriología al diagnóstico es escaso, empleándose en 0-4 años el aspirado o lavado gástrico. Para el cultivo se usan los medios sólidos a base de huevo o, en laboratorios de referencia, los de detección temprana. Las pruebas de amplificación de ácidos nucleicos están disponibles en algunos laboratorios, pero sin un sistema de garantía de calidad; sus resultados deben considerarse sólo dentro del contexto clínico. El fortalecimiento de la red de laboratorios de cultivo facilitará el diagnóstico de certeza de la TBC infantil, la confiabilidad de la notificación, y el conocimiento de la resistencia bacteriana. Para revertir la actual situación epidemiológica es necesario incrementar la investigación de los niños contactos de casos bacilíferos, seguida de quimioprofilaxis o tratamiento según corresponda. La meningitis TBC en menores de 5 años tuvo una disminución significativamente mayor que la de la TBC en adultos, en los últimos 20 años en Argentina. En 2000 se notificaron sólo 10 casos de meningitis en esas edades (0.29/ 100.000). Esto confirma la protección conferida por la vacunación BCG al nacimiento, con alta y continuada cobertura. (EN) TB notification rate in infants and children 0-4 years was 24.3/ 100.000 in Argentina, in 2000, for a global incidence of 31.8/ 100.000. A 17% of all TB cases occurred in children (0-14 years), indicating a very active TB transmission. Usually TB is diagnosed when the disease is already advanced. Main criteria for the diagnosis are: a previous contact with an infectious TB patient, a positive PPD test result and clinical - radiological signs and symptoms. Bacteriology plays a limited role in diagnosis; gastric aspirate is the most often used specimen for bacteriological examination in children. Culture is performed on solid egg-media, but other more recently developed culture media systems are available in reference laboratories. Nucleic acid amplification assays are also used, but its systematic quality control is still lacking. Their results should be considered only as complementary. Strengthening of the laboratory network will contribute to increase diagnostic certainty of childhood TB, to improve reliability of cases reported, and to a better knowledge of the drug resistance profile. Early diagnosis of TB in children, by contacts investigation of infectious patients, followed by preventive chemotherapy or treatment when necessary, may revert the current epidemiological situation. TB meningitis in the 0-4 years group showed a significantly more pronounced decline than that of adults TB for the period 1980-2000, (only 10 meningitis cases were diagnosed in year 2000, 0.29/ 100.000), confirming the protection conferred by BCG vaccination when applied to newborns with a continuously high coverage

Usefulness of the enzyme immunoassay in the diagnosis of tuberculosis

Fil: de Kantor, I N. Centro Panamericano de Zoonosis (CEPANZO, OPS/OMS), Buenos Aires; Argentina.Fil: Barrera, Lucía. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Miceli, Isabel N. P. Dirección de Epidemiología, Ministerio de Salud, Buenos Aires; Argentina.To assess the usefulness of enzyme immunoassay as a rapid method of diagnosing tuberculosis, a study was conducted of 687 serum samples from 271 children and 416 adults. With 55 sera from nontuberculous children as controls, the specificity was 0.98, and with 137 controls from the adult population, 0.93. Prior vaccination with BCG did not influence the level of detectable anti-PPD antibody. The results were similar in healthy PPD-positive and negative adults. The test differentiated mycoses and nontuberculous mycobacterioses from tuberculosis. The sensitivity rates in 49 children and 200 adults diagnosed with bacteriologically confirmed pulmonary and extrapulmonary tuberculosis were calculated at 0.51 and 0.69, respectively. In those tuberculosis cases not bacteriologically confirmed or at other sites, the test was positive in 28.1% of 114 children and in 48.6% of 35 adults. The cost, speed, and availability of reagents for this test were comparable to those for direct microscopic examination. Both methods were positive for 49% of the tuberculosis cases confirmed by culture, and a total of 84% of those cases were found positive using one method or the other. It is concluded that enzyme immunoassay can be especially useful in the rapid diagnosis of nonbacilliferous pulmonary, extrapulmonary, and childhood tuberculosis

Usefulness of the enzyme immunoassay in the diagnosis of tuberculosis

Fil: de Kantor, I N. Centro Panamericano de Zoonosis (CEPANZO, OPS/OMS), Buenos Aires; Argentina.Fil: Barrera, Lucía. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Miceli, Isabel N. P. Dirección de Epidemiología, Ministerio de Salud, Buenos Aires; Argentina.To assess the usefulness of enzyme immunoassay as a rapid method of diagnosing tuberculosis, a study was conducted of 687 serum samples from 271 children and 416 adults. With 55 sera from nontuberculous children as controls, the specificity was 0.98, and with 137 controls from the adult population, 0.93. Prior vaccination with BCG did not influence the level of detectable anti-PPD antibody. The results were similar in healthy PPD-positive and negative adults. The test differentiated mycoses and nontuberculous mycobacterioses from tuberculosis. The sensitivity rates in 49 children and 200 adults diagnosed with bacteriologically confirmed pulmonary and extrapulmonary tuberculosis were calculated at 0.51 and 0.69, respectively. In those tuberculosis cases not bacteriologically confirmed or at other sites, the test was positive in 28.1% of 114 children and in 48.6% of 35 adults. The cost, speed, and availability of reagents for this test were comparable to those for direct microscopic examination. Both methods were positive for 49% of the tuberculosis cases confirmed by culture, and a total of 84% of those cases were found positive using one method or the other. It is concluded that enzyme immunoassay can be especially useful in the rapid diagnosis of nonbacilliferous pulmonary, extrapulmonary, and childhood tuberculosis

Rotavirus laboratory network: results after one year of observation

Fil: Bok, Karin. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología; Argentina.Fil: Castagnaro, N C. Instituto de Virología Luis C. Verna, Universidad Nacional de Tucumán; ArgentinaFil: Diaz, N E. Departamento de Inmunoquímica, Centro de Ingeniería Genética y Biotecnología; Cuba.Fil: Borsa, Ana. Laboratorio de Virología, Hospital Infantil Sor María Ludovica, La Plata; ArgentinaFil: Nates, Silvia V. Instituto de Virología JM Vanella, Universidad Nacional de Córdoba; ArgentinaFil: Espul, Carlos. Sección Sección Virología, Hospital Central de Mendoza; ArgentinaFil: Cuello, Héctor. Hospital Central. Sección Virología; Argentina.Fil: Fay O. Centro Tecnológico de Salud Pública, Rosario; ArgentinaFil: Brunet, B. Departamento de Medicina Interna, Hospital Infantil Víctor J. Vilela, Rosario; ArgentinaFil: Ues, O C. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Epidemiología; Argentina.Fil: Santoro, R. Departamento de Mecanismos Moleculares de Enfermedades, DMMD, Universidad de Zurich; Suiza.Fil: Grinstein, S. Laboratorio de Virología, Hospital de Niños, Buenos Aires; ArgentinaFil: Gonzalez, F. Instituto de Virología, CICVyA, INTA-Castelar, Buenos Aires, Argentina.Fil: Miceli, Isabel N. P. Dirección de Epidemiología, Ministerio de Salud, Buenos Aires; ArgentinaFil: Gomez, Jorge A. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología; Argentina.Rotavirus is the most common cause of severe diarrhea in children and it has been estimated that in Argentina Rotavirus is responsible for 21,000 hospitalizations, 85,000 medical attentions and an annual medical cost of US$ 27 millions. Given that a Rotavirus vaccine is about to be approved, a laboratory network based surveillance system was organized. Herein, we present the results after one year of study. Severe diarrhea was responsible for 9% of pediatric hospitalizations and rotavirus was detected in 42.1% of the diarrhea cases. We estimated that Rotavirus causes 3.8% of pediatric hospitalizations. The number of diarrhea and Rotavirus diarrhea hospitalizations was greater during the first year of life (62% and 71.3%, respectively). The number of diarrhea hospitalizations during the December-May semester was significantly higher than the rest of the year. A Rotavirus diarrhea peak was detected between April and June. These results indicate that Rotavirus is the most important etiological agent of severe diarrhea in Argentine children and show the importance of performing Rotavirus diagnosis in every pediatric hospital. The additional costs will be compensated by many benefits such as better use of antibiotics, improved nosocomial spread control, better handling of hospital beds and of laboratory resources and of the hospitalized patient

Rotavirus laboratory network: results after one year of observation

Fil: Bok, Karin. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología; Argentina.Fil: Castagnaro, N C. Instituto de Virología Luis C. Verna, Universidad Nacional de Tucumán; ArgentinaFil: Diaz, N E. Departamento de Inmunoquímica, Centro de Ingeniería Genética y Biotecnología; Cuba.Fil: Borsa, Ana. Laboratorio de Virología, Hospital Infantil Sor María Ludovica, La Plata; ArgentinaFil: Nates, Silvia V. Instituto de Virología JM Vanella, Universidad Nacional de Córdoba; ArgentinaFil: Espul, Carlos. Sección Sección Virología, Hospital Central de Mendoza; ArgentinaFil: Cuello, Héctor. Hospital Central. Sección Virología; Argentina.Fil: Fay O. Centro Tecnológico de Salud Pública, Rosario; ArgentinaFil: Brunet, B. Departamento de Medicina Interna, Hospital Infantil Víctor J. Vilela, Rosario; ArgentinaFil: Ues, O C. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Epidemiología; Argentina.Fil: Santoro, R. Departamento de Mecanismos Moleculares de Enfermedades, DMMD, Universidad de Zurich; Suiza.Fil: Grinstein, S. Laboratorio de Virología, Hospital de Niños, Buenos Aires; ArgentinaFil: Gonzalez, F. Instituto de Virología, CICVyA, INTA-Castelar, Buenos Aires, Argentina.Fil: Miceli, Isabel N. P. Dirección de Epidemiología, Ministerio de Salud, Buenos Aires; ArgentinaFil: Gomez, Jorge A. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Virología; Argentina.Rotavirus is the most common cause of severe diarrhea in children and it has been estimated that in Argentina Rotavirus is responsible for 21,000 hospitalizations, 85,000 medical attentions and an annual medical cost of US$ 27 millions. Given that a Rotavirus vaccine is about to be approved, a laboratory network based surveillance system was organized. Herein, we present the results after one year of study. Severe diarrhea was responsible for 9% of pediatric hospitalizations and rotavirus was detected in 42.1% of the diarrhea cases. We estimated that Rotavirus causes 3.8% of pediatric hospitalizations. The number of diarrhea and Rotavirus diarrhea hospitalizations was greater during the first year of life (62% and 71.3%, respectively). The number of diarrhea hospitalizations during the December-May semester was significantly higher than the rest of the year. A Rotavirus diarrhea peak was detected between April and June. These results indicate that Rotavirus is the most important etiological agent of severe diarrhea in Argentine children and show the importance of performing Rotavirus diagnosis in every pediatric hospital. The additional costs will be compensated by many benefits such as better use of antibiotics, improved nosocomial spread control, better handling of hospital beds and of laboratory resources and of the hospitalized patient