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Jeffrey R. Starke - One of the best experts on this subject based on the ideXlab platform.
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Advanced imaging tools for Childhood Tuberculosis: potential applications and research needs
The Lancet. Infectious diseases, 2020Co-Authors: Sanjay K. Jain, Jeffrey R. Starke, Savvas Andronikou, Pierre Goussard, Sameer Antani, David Gomez-pastrana, Christophe Delacourt, Alvaro A. Ordonez, Patrick Jean-philippe, Renee BrowningAbstract:Tuberculosis is the leading cause of death globally that is due to a single pathogen, and up to a fifth of patients with Tuberculosis in high-incidence countries are children younger than 16 years. Unfortunately, the diagnosis of Childhood Tuberculosis is challenging because the disease is often paucibacillary and it is difficult to obtain suitable specimens, causing poor sensitivity of currently available pathogen-based tests. Chest radiography is important for diagnostic evaluations because it detects abnormalities consistent with Childhood Tuberculosis, but several limitations exist in the interpretation of such results. Therefore, other imaging methods need to be systematically evaluated in children with Tuberculosis, although current data suggest that when available, cross-sectional imaging, such as CT, should be considered in the diagnostic evaluation for Tuberculosis in a symptomatic child. Additionally, much of the understanding of Childhood Tuberculosis stems from clinical specimens that might not accurately represent the lesional biology at infection sites. By providing non-invasive measures of lesional biology, advanced imaging tools could enhance the understanding of basic biology and improve on the poor sensitivity of current pathogen detection systems. Finally, there are key knowledge gaps regarding the use of imaging tools for Childhood Tuberculosis that we outlined in this Personal View, in conjunction with a proposed roadmap for future research.
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New Diagnostics for Childhood Tuberculosis
Infectious disease clinics of North America, 2015Co-Authors: Silvia S. Chiang, Douglas S. Swanson, Jeffrey R. StarkeAbstract:The challenge of diagnosing Childhood Tuberculosis (TB) results from its paucibacillary nature and the difficulties of sputum collection in children. Mycobacterial culture, the diagnostic gold standard, provides microbiological confirmation in only 30% to 40% of Childhood pulmonary TB cases and takes up to 6 weeks to result. Conventional drug susceptibility testing requires an additional 2 to 4 weeks after culture confirmation. In response to the low sensitivity and long wait time of the traditional diagnostic approach, many new assays have been developed. These new tools have shortened time to result; however, none of them offer greater sensitivity than culture.
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the global nature of Childhood Tuberculosis
Pediatrics, 2014Co-Authors: Jeffrey R. Starke, Andrea T CruzAbstract:* Abbreviations: CDC — : Centers for Disease Control and Prevention LTBI — : latent Tuberculosis infection TB — : Tuberculosis WHO — : World Health Organization After several decades of neglect, Childhood Tuberculosis (TB) is receiving some of the attention it deserves. Although the common perception is that TB has disappeared from the United States, there are almost 10 000 cases annually, with >1000 occurring in children.1 There are many thousands of children with untreated latent TB infection (LTBI) at risk of developing TB disease, who either were missed during contact investigation of adults with TB disease in the United States or who were not tested during immigration to the United States. Pang et al2 describe the epidemiology of TB in preschool-aged US children. They highlight and quantify a recently described risk factor for Childhood TB in a low-incidence setting: parental foreign birth. A 2012 Pediatrics article found that two-thirds of all children and adolescents with TB in the United States had at least 1 foreign-born parent, and only one-quarter of children with TB lacked an international connection.3 Before 2009, children immigrating to the United States were not routinely tested for LTBI or TB disease. The 2009 Centers for Disease Control and Prevention (CDC) Technical Instructions for children immigrating to the United States endorse testing children ages 2 to 14 years for LTBI and treatment of infected children after arrival in the United States.4 The hope is that this immigration screening protocol will decrease the reservoir for future cases among the foreign-born. However, some US-born children with LTBI are not detected by existing screening algorithms. Having a foreign-born parent is not currently included as a risk factor in the American Academy of Pediatrics–endorsed LTBI screening questionnaire … Address correspondence to Jeffrey R. Starke, MD, 1102 Bates St, Suite 1150, Houston, TX 77030. E-mail: jstarke{at}bcm.edu
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New concepts in Childhood Tuberculosis.
Current opinion in pediatrics, 2007Co-Authors: Jeffrey R. StarkeAbstract:Purpose of reviewChildhood Tuberculosis has long been neglected in international Tuberculosis control efforts. There are, however, many opportunities to prevent Childhood Tuberculosis that are not being fully employed.Recent findingsSeveral papers have been published to emphasize the unique nature o
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Childhood Tuberculosis: treatment strategies and recent advances.
Paediatric respiratory reviews, 2001Co-Authors: Jeffrey R. StarkeAbstract:Over the past 20 years, several major studies have shown that 6-month therapy, initially using isoniazid, rifampin and pyrazinamide, is highly effective and extremely safe for the treatment of most forms of Childhood Tuberculosis. The various drug schedules and frequency of administration will be reviewed. Directly observed therapy is an essential component of a paediatric Tuberculosis treatment plan, though using it does not solve all problems with adherence to treatment. As the rates of drug-resistant Tuberculosis increase around the world, special aspects of paediatric Tuberculosis will have to be considered when designing treatment regimens for children. Finally, the next frontier of antiTuberculosis therapy may be the manipulation of the host immune system.
Ben J. Marais - One of the best experts on this subject based on the ideXlab platform.
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Update on Childhood Tuberculosis
2013Co-Authors: Ben J. MaraisAbstract:The burden of Childhood Tuberculosis remains poorly known in the world. The diagnosis is challenging because Tuberculosis in children is generally bacteriologically negative. Recent studies have described diagnostic techniques involving molecular biology, advances in the standard treatment and new antiTuberculosis drugs, however, the diagnosis continues to be based on current clinical data, radiological imaging studies and epidemiological investigation. Over the last decade, the treatment of Childhood Tuberculosis has improved because of scientific advances and international standardization of practices.
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Trends in Childhood Tuberculosis in Zambia: a situation analysis.
Journal of tropical pediatrics, 2012Co-Authors: Nathan Kapata, Ben J. Marais, Martin P. Grobusch, Pascalina Chanda-kapata, Justin O'grady, Matthew Bates, Peter Mwaba, Saskia Janssen, Frank Cobelens, Alimuddin ZumlaAbstract:Objectives: To ascertain Childhood Tuberculosis (TB) trends, human immunodeficiency virus (HIV) co-infection rates and multi-drug resistant TB (MDR-TB) prevalence rates in Zambia. Methods: A retrospective review of Zambian annual TB notification data and National TB Programme reports for a 7 year period (2004-2011). TB trends were stratified by age and HIV status. Results: The total number of children notified during this period with all forms of TB was 40 976. A total of 2670 of 40 976 (6%) were smear-positive cases. Notification rates of all forms of Childhood TB show a decline in trends from 135 per 100 000 population in 2004, to 69 per 100 000 population in 2011. Conclusions: Childhood TB is an important but neglected problem in Zambia highlighted by the fact that no data exists on HIV co-infection and MDR-TB. Strengthening of the National TB Programme and diagnostics services/algorithms are required to accurately define the TB burden, HIV co-infection and MDR-TB rates in children in Zambia.
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Childhood Tuberculosis: epidemiology and natural history of disease.
Indian journal of pediatrics, 2011Co-Authors: Ben J. MaraisAbstract:Despite previous misperceptions that Childhood Tuberculosis (TB) is less relevant, since children tend to develop mild disease, contribute little to transmission and do not impact epidemic control, awareness is growing that TB is an important preventable cause of disease and death among children in TB endemic areas. At an operational level there remains an urgent need for feasible and implementable policies to guide management in resource limited settings. This manuscript reviews the epidemiology and natural history of TB in children in order to improve understanding of the various disease entities encountered and to provide the rationale for different management approaches.
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Childhood Tuberculosis: An Emerging and Previously Neglected Problem
Infectious disease clinics of North America, 2010Co-Authors: Ben J. Marais, H. Simon SchaafAbstract:Although awareness is growing, Childhood Tuberculosis (TB) remains a neglected disease in many resource-limited settings. In part this reflects operational difficulties, lack of visibility in official reports, as well as perceptions that children tend to develop mild disease, contribute little to disease transmission, and do not affect epidemic control. At an international level there is greater appreciation that children contribute significantly to the global TB disease burden and suffer severe TB-related morbidity and mortality, particularly in TB-endemic areas, where the disease often remains undiagnosed. However, this is not always the case at the national or local level and there remains an urgent need for feasible and implementable policies to guide clinical practice. Pediatric TB can be regarded as an emerging epidemic in areas where the adult epidemic remains out of control and Mycobacterium Tuberculosis transmission is ongoing. This article reviews important concepts, challenges, and management principles related to Childhood TB; it also summarizes the main priorities for future research.
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Culture-confirmed Childhood Tuberculosis in Cape Town, South Africa: a review of 596 cases
BMC infectious diseases, 2007Co-Authors: H. Simon Schaaf, Ben J. Marais, Andrew Whitelaw, Anneke C. Hesseling, Brian Eley, Gregory D. Hussey, Peter R. DonaldAbstract:Background The clinical, radiological and microbiological features of culture-confirmed Childhood Tuberculosis diagnosed at two referral hospitals are described.
Madhukar Pai - One of the best experts on this subject based on the ideXlab platform.
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New approaches and emerging technologies in the diagnosis of Childhood Tuberculosis.
Paediatric respiratory reviews, 2007Co-Authors: Ben J. Marais, Madhukar PaiAbstract:Childhood Tuberculosis (TB) has long been neglected by TB control programmes, as children tend to develop sputum smear-negative disease and rarely contribute to disease transmission. However, children suffer severe TB-related morbidity and mortality in areas with endemic TB and carry a significant proportion of the global disease burden. Apart from improved control of the global TB epidemic, access to accurate diagnosis and effective treatment is essential to reduce the disease burden associated with Childhood TB. Access to child friendly anti-TB treatment is improving, but establishing an accurate diagnosis remains a challenge. This review provides an overview of recent advances in the diagnosis of Childhood TB, focusing on bacteriological, immunological, radiological and symptom-based approaches. It is possible to establish a fairly accurate diagnosis of either latent infection or active TB in immunocompetent children, even in resource-limited settings, but establishing an accurate diagnosis of TB in HIV-infected (immunocompromised) children remains a major challenge.
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Recent advances in the diagnosis of Childhood Tuberculosis
Archives of disease in childhood, 2007Co-Authors: Ben J. Marais, Madhukar PaiAbstract:Children account for a major proportion of the global Tuberculosis disease burden, especially in endemic areas. However, the accurate diagnosis of Childhood Tuberculosis remains a major challenge. This review provides an overview of the most important recent advances in the diagnosis of intrathoracic Childhood Tuberculosis: (1) symptom-based approaches, including symptom-based screening of exposed children and symptom-based diagnosis of active disease; (2) novel immune-based approaches, including T cell assays and novel antigen-based tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for Tuberculosis diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active Tuberculosis in children, but establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge, particularly in high-burden settings. Although improved access to diagnosis and treatment is essential, ultimately the burden of Childhood Tuberculosis is determined by the level of epidemic control achieved in a particular community. Several recent initiatives, in particular the United Nations Millennium Developmental Goals, deal with the problem of poverty and disease in a holistic fashion, but global political commitment is required to support these key initiatives.
Peter R. Donald - One of the best experts on this subject based on the ideXlab platform.
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Edith Lincoln, an American pioneer of Childhood Tuberculosis
The Pediatric infectious disease journal, 2013Co-Authors: Peter R. DonaldAbstract:Edith Lincoln (1899-1971), one of the most influential American pediatricians to study Childhood Tuberculosis, managed more than a thousand children from time of Tuberculosis infection into adult life. She spoke with authority regarding the prognosis of Childhood Tuberculosis. Her observations of chemotherapy in children treated with isoniazid led directly to chemoprophylaxis, now of great importance in the management of the human immunodeficiency syndrome.
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Culture-confirmed Childhood Tuberculosis in Cape Town, South Africa: a review of 596 cases
BMC infectious diseases, 2007Co-Authors: H. Simon Schaaf, Ben J. Marais, Andrew Whitelaw, Anneke C. Hesseling, Brian Eley, Gregory D. Hussey, Peter R. DonaldAbstract:Background The clinical, radiological and microbiological features of culture-confirmed Childhood Tuberculosis diagnosed at two referral hospitals are described.
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A research agenda to promote the management of Childhood Tuberculosis within national Tuberculosis programmes.
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2007Co-Authors: Peter R. Donald, D Maher, S QaziAbstract:Despite causing considerable mortality and morbidity Childhood Tuberculosis (TB) is a neglected aspect of national Tuberculosis programmes (NTPs) particularly in developing countries. A recently published World Health Organization (WHO) document Guidance for national Tuberculosis programmes on the management of Tuberculosis in children addresses the effective management of children within NTPs. Taking into account this document and following a literature review research priorities are identified to promote the integration of Childhood Tuberculosis into NTPs. The implications of human immunodeficiency virus (HIV) infection apply to all aspects of this agenda. The major priorities are: The prospective evaluation of the incidence of Childhood TB and the monitoring of programme performance with regard to Childhood TB. A lot of data are already available within many programmes that could inform this process; Study of the criteria to suspect and diagnose Childhood TB using uniform criteria as defined in the Guidance document mentioned above. Evaluate new methodologies for this purpose; Study the pharmacokinetics and toxicity of antiTuberculosis drugs in children and the long-term outcome of the treatment of children; Determine how many Childhood contacts of adult pulmonary TB qualify for chemoprophylaxis in different communities. Study chemoprophylaxis for drug-resistant TB and chemoprophylaxis among certain groups of adolescents; Document at what level children enter NTPs the availability of qualified staff and their effectiveness in performing diagnostic investigations and ensuring quality care. Study the role of families as agents for DOTS evaluate private sector participation in Childhood TB management; Document bacille Calmette-Guerin (BCG) immunisation complications and study management strategies. (authors)
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Childhood Tuberculosis: out of control?
Current opinion in pulmonary medicine, 2002Co-Authors: Peter R. DonaldAbstract:Because of the difficulty of confirming the diagnosis of Childhood Tuberculosis and because children do not make a significant contribution to the spread of Tuberculosis, the burden of Childhood Tuberculosis in the world is uncertain. Several estimates make use of an arbitrary calculation assigning
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Twice weekly vs. daily chemotherapy for Childhood Tuberculosis.
The Pediatric infectious disease journal, 2000Co-Authors: J M Te Water Naude, Peter R. Donald, G. Hussey, Maurice Kibel, Arno Louw, D.r. Perkins, H. S. SchaafAbstract:Background.Treating Childhood Tuberculosis places a large burden on health services, and ways of lessening this were sought.Methods.A randomized controlled trial was conducted to determine the effectiveness of fully intermittent twice weekly treatment for intrathoracic Childhood Tuberculosis and its
Douglas S. Swanson - One of the best experts on this subject based on the ideXlab platform.
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New Diagnostics for Childhood Tuberculosis
Infectious disease clinics of North America, 2015Co-Authors: Silvia S. Chiang, Douglas S. Swanson, Jeffrey R. StarkeAbstract:The challenge of diagnosing Childhood Tuberculosis (TB) results from its paucibacillary nature and the difficulties of sputum collection in children. Mycobacterial culture, the diagnostic gold standard, provides microbiological confirmation in only 30% to 40% of Childhood pulmonary TB cases and takes up to 6 weeks to result. Conventional drug susceptibility testing requires an additional 2 to 4 weeks after culture confirmation. In response to the low sensitivity and long wait time of the traditional diagnostic approach, many new assays have been developed. These new tools have shortened time to result; however, none of them offer greater sensitivity than culture.
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WHY Childhood Tuberculosis IS NOT PREVENTED. † 668
Pediatric Research, 1996Co-Authors: Douglas S. Swanson, Lydia T. Ong, Jeffrey R. StarkeAbstract:Most cases of Childhood Tuberculosis (TB) result from the primary infection, indicating recent transmission. Rapid contact investigation of adult TB cases is essential for preventing Childhood Tuberculosis by interrupting transmission and providing early treatment of infection in the child. An important indicator of the effectiveness of a TB control program is the proportion of Childhood TB cases that could have been prevented under optimal conditions. We compared the epidemiology of preventable cases of Childhood TB in Houston from 1985 through 1987 with those from 1994 through June 1995, following changes implemented to improve the TB case contact tracing and monitoring of therapy.