6 research outputs found
Radiological findings in young children investigated for tuberculosis in Mozambique
INTRODUCTION: Chest radiography remains a critical tool for
diagnosing intrathoracic tuberculosis (TB) in young children who
are unable to expectorate. We describe the radiological findings
in children under 3 years of age investigated for TB in the
district of Manhica, southern Mozambique, an area with a high
prevalence of TB and HIV. METHODS: Digital antero-posterior and
lateral projections were performed and reviewed by two
independent readers, using a standardized template. Readers
included a local pediatrician and a pediatric radiologist
blinded to all clinical information. International consensus
case definitions for intra-thoracic TB in children were applied.
RESULTS: A total of 766 children were evaluated of whom 43
(5.6%) had TB. The most frequent lesion found in TB cases was
air space consolidation (65.1%), followed by suggestive hilar
lymphadenopathy (17.1%) and pleural effusion (7.0%). Air space
consolidation was significantly more common in TB cases than in
non-TB cases (odds ratio 8.9; 95% CI: 1.6-50.5), as were hilar
lymphadenopathy (OR 17.2; 95% CI: 5.7-52.1). The only case with
miliary infiltrates and 3 with pleural effusions occurred in
HIV-infected children. CONCLUSION: Frequent air space
consolidation complicates radiological distinction between TB
and bacterial pneumonia in young children, underscoring the need
for epidemiological contextualization and consideration of all
relevant signs and symptoms
Incidence of Tuberculosis Among Young Children in Rural Mozambique
BACKGROUND: Tuberculosis (TB) contributes significantly to child
morbidity and mortality. This study aimed to estimate the
minimum community-based incidence rate of TB among children
<3 years of age in Southern Mozambique. METHODS: Between
October 2011 and October 2012, in the Manhica District Health
and Demographic Surveillance System, we enrolled prospectively
all presumptive TB cases younger than 3 years of age through
passive and active case finding. Participants included all
children who were either symptomatic or were close contacts of a
notified adult smear-positive pulmonary TB. Children were
clinically evaluated at baseline and follow-up visits.
Investigation for TB disease included chest radiography, HIV and
tuberculin skin testing as well as gastric aspirate and induced
sputum sampling, which were processed for smear, culture and
mycobacterial molecular identification. RESULTS: During the
study period, 13,764 children <3 years contributed to a total
of 9575 person-year. Out of the 789 presumptive TB cases
enrolled, 13 had TB culture confirmation and 32 were probable TB
cases. The minimum community-based incidence rate of TB
(confirmed plus probable cases) was 470 of 100,000 person-year
(95% confidence interval: 343-629 of 100,000). HIV co-infection
was present in 44% of the TB cases. CONCLUSION: These data
highlight the huge burden of pediatric TB. This study provides
one of the first prospective population-based incidence data of
childhood tuberculosis and adds valuable information to the
global effort of producing better estimates, a critical step to
inform public health policy
Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project.
Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs
Radiological findings in young children investigated for tuberculosis in mozambique
INTRODUCTION: Chest radiography remains a critical tool for
diagnosing intrathoracic tuberculosis (TB) in young children who
are unable to expectorate. We describe the radiological findings
in children under 3 years of age investigated for TB in the
district of Manhica, southern Mozambique, an area with a high
prevalence of TB and HIV. METHODS: Digital antero-posterior and
lateral projections were performed and reviewed by two
independent readers, using a standardized template. Readers
included a local pediatrician and a pediatric radiologist
blinded to all clinical information. International consensus
case definitions for intra-thoracic TB in children were applied.
RESULTS: A total of 766 children were evaluated of whom 43
(5.6%) had TB. The most frequent lesion found in TB cases was
air space consolidation (65.1%), followed by suggestive hilar
lymphadenopathy (17.1%) and pleural effusion (7.0%). Air space
consolidation was significantly more common in TB cases than in
non-TB cases (odds ratio 8.9; 95% CI: 1.6-50.5), as were hilar
lymphadenopathy (OR 17.2; 95% CI: 5.7-52.1). The only case with
miliary infiltrates and 3 with pleural effusions occurred in
HIV-infected children. CONCLUSION: Frequent air space
consolidation complicates radiological distinction between TB
and bacterial pneumonia in young children, underscoring the need
for epidemiological contextualization and consideration of all
relevant signs and symptoms
Radiological findings in young children investigated for tuberculosis in mozambique
INTRODUCTION: Chest radiography remains a critical tool for
diagnosing intrathoracic tuberculosis (TB) in young children who
are unable to expectorate. We describe the radiological findings
in children under 3 years of age investigated for TB in the
district of Manhica, southern Mozambique, an area with a high
prevalence of TB and HIV. METHODS: Digital antero-posterior and
lateral projections were performed and reviewed by two
independent readers, using a standardized template. Readers
included a local pediatrician and a pediatric radiologist
blinded to all clinical information. International consensus
case definitions for intra-thoracic TB in children were applied.
RESULTS: A total of 766 children were evaluated of whom 43
(5.6%) had TB. The most frequent lesion found in TB cases was
air space consolidation (65.1%), followed by suggestive hilar
lymphadenopathy (17.1%) and pleural effusion (7.0%). Air space
consolidation was significantly more common in TB cases than in
non-TB cases (odds ratio 8.9; 95% CI: 1.6-50.5), as were hilar
lymphadenopathy (OR 17.2; 95% CI: 5.7-52.1). The only case with
miliary infiltrates and 3 with pleural effusions occurred in
HIV-infected children. CONCLUSION: Frequent air space
consolidation complicates radiological distinction between TB
and bacterial pneumonia in young children, underscoring the need
for epidemiological contextualization and consideration of all
relevant signs and symptoms
Incidence of Tuberculosis Among Young Children in Rural Mozambique
BACKGROUND: Tuberculosis (TB) contributes significantly to child
morbidity and mortality. This study aimed to estimate the
minimum community-based incidence rate of TB among children
<3 years of age in Southern Mozambique. METHODS: Between
October 2011 and October 2012, in the Manhica District Health
and Demographic Surveillance System, we enrolled prospectively
all presumptive TB cases younger than 3 years of age through
passive and active case finding. Participants included all
children who were either symptomatic or were close contacts of a
notified adult smear-positive pulmonary TB. Children were
clinically evaluated at baseline and follow-up visits.
Investigation for TB disease included chest radiography, HIV and
tuberculin skin testing as well as gastric aspirate and induced
sputum sampling, which were processed for smear, culture and
mycobacterial molecular identification. RESULTS: During the
study period, 13,764 children <3 years contributed to a total
of 9575 person-year. Out of the 789 presumptive TB cases
enrolled, 13 had TB culture confirmation and 32 were probable TB
cases. The minimum community-based incidence rate of TB
(confirmed plus probable cases) was 470 of 100,000 person-year
(95% confidence interval: 343-629 of 100,000). HIV co-infection
was present in 44% of the TB cases. CONCLUSION: These data
highlight the huge burden of pediatric TB. This study provides
one of the first prospective population-based incidence data of
childhood tuberculosis and adds valuable information to the
global effort of producing better estimates, a critical step to
inform public health policy