Immune response to BCG vaccination in children

The world-wide programme of mass BCG vaccination started in 1921' and used extensively since the forties has provided evidence that BCG vaccine has a protective value. This was confirmed by studies done on experimental animals.2 Despite this, no vaccination has become more controversial than BCG vaccination in recent times. The protection conferred by BCG vaccination in children is important because of the serious consequences of tuberculosis in them. The aim of this study was to assess the immunological response of children to BCG vaccination

Evaluation of PCR Using TRC4 and IS6110 Primers in Detection of Tuberculous Meningitis

We have evaluated a new set of primers (TRC4) in comparison with the IS6110 primers commonly used in PCR to detect tuberculous meningitis among children. The levels of concordance between the results of IS6110 PCR and TRC4 PCR with cerebrospinal fluid specimens from patients with clinically confirmed tuberculous meningitis were 80 and 86%, respectively. Results with the two primer sets were concordant for 55 positive and 22 negative specimens (n 5 98). We conclude that the sensitivity of PCR can be increased by using both IS6110 and TRC4 primers

A Profile of Bacteriologically Confirmed Pulmonary Tuberculosis in Children

Objective: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. Study Design: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. Results: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. Conclusions: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area

Immunological Spectrum of Childhood Tuberculosis

Fifty-three children with tuberculous meningitis (TBM) were studied in parallel with 37 children with primary pulmonary complex (PPC), 32 tuberculin skin positive controls, and 38 skin negative controls for immunological evaluation. Proportions of peripheral blood total T and T helper lymphocytes (TH) were significantly reduced in TBM (TSS, TH32) as compared to PPC (T70, TH40) and Controls (T74, TH43), but response to mitogens phytohaemagglutinin (PHA) and poke weed mitogen (Pwm) were comparable in all the groups. Response of peripheral blood lymphocytes to tubercular protein (PPD) was significantly greater in the tuberculin skin positive group, but comparable between the TBM and PPC groups. There was no significant difference in the proportion of B lymphocytes, antibody levels to PPD and monocyte capacity to release hydrogen peroxide in the four groups. These findings suggest that there is no definite immunological spectrum in childhood tuberculosis

A profile of bacteriologically confirmed pulmonary tuberculosis in children

Objective: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. Study Design: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. Results: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. Conclusions: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area