Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices
Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices
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DOI：
10.1093/jpids/piu020
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发表时间：
2015-03-01
影响因子：
3.2
通讯作者：
Fenner, Lukas
中科院分区：
文献类型：
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作者：
Ballif, Marie;Renner, Lorna;Fenner, Lukas
背景儿童结核病（TB）的全球负担估计为每年50万新病例。感染人类免疫缺陷病毒（艾滋病毒）的儿童患结核病的风险很高。艾滋病毒感染儿童的结核病诊断仍然是一个重大挑战。我们描述了非洲、亚洲、加勒比海地区和中南美洲的儿科抗逆转录病毒治疗（ART）项目的结核病诊断和筛查实践。我们使用基于网络的问卷来收集2012年3月至7月期间ART项目和患者的数据。来自23个国家的43个ART项目参与了这项研究。所有项目均提供了痰液显微镜检查和胸部X线片，40个（93%）研究中心进行了分枝杆菌培养，27个（63%）研究中心进行了胃抽吸，23个（54%）研究中心进行了诱导痰，16个（37%）研究中心进行了Xpert MTB/RIF。在开始抗逆转录病毒治疗前排除活动性结核病的筛查做法包括41个地点（84%）的接触史，38个地点（88%）的症状筛查和34个地点（79%）的胸部X光片。在研究期间，对146名被诊断患有结核病的儿童进行了诊断工具的使用检查。125例（86%）儿童使用胸片，76例（52%）使用痰镜检，38例（26%）使用诱导痰镜检，35例（24%）使用胃穿刺液镜检，25例（17%）使用培养，11例（8%）使用Xpert MTB/RIF。诱导痰和Xpert MTB/RIF很少用于诊断儿童结核病，筛查主要基于症状识别。迫切需要提高低收入和中等收入国家抗逆转录病毒治疗方案的能力，以排除和诊断艾滋病毒感染儿童的结核病。
Background. The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge.Methods. We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study.Results. Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children.Conclusions. Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low-and middle-income countries to exclude and diagnose TB in HIV-infected children.