Novel techniques for the detection of Pediatric TB in Ethiopia

描述(申请人提供)：埃塞俄比亚检测儿童结核病的新技术摘要在艾滋病毒和结核病发病率高的资源有限的环境中，儿童结核病的诊断受到缓慢、低效和昂贵的方法的严重限制，从而导致发病率和死亡率的增加。我们的研究团队在开发新的结核病诊断工具方面取得了重大进展，这些工具在成人中显示出比黄金标准诊断方法显著的优势。我们建议评估这些新工具以及其他工具在0-5岁儿童中检测和直接检测结核分枝杆菌(Mtb)的潜力。该项目将以埃塞俄比亚为背景，那里的儿科结核病和艾滋病毒混合感染是主要问题。我们推测，与目前的标准技术相比，儿童活动性结核病的诊断和从这些儿童中恢复结核分枝杆菌分离株可以更快、更有效、更经济地使用替代临床标本，并结合更快速的诊断方法来确认结核病和检测耐药性。如果我们的假设是正确的，使用这些方法将使临床医生能够针对受感染儿童的细菌分离株进行快速治疗，从而提高抗结核治疗的速度和结果。为了评估这些技术的潜在效用，我们提出了两项研究。在第一项研究中，我们将使用创新的、廉价的测试来评估对各种临床样本的测试，这些测试可能会极大地促进在结核病和艾滋病毒混合感染率较高的发展中国家诊断儿童结核病。第二项研究将包括确诊为结核病的儿童(在第一项研究中确认)和年龄匹配的健康儿童。我们将评估三种基于免疫学的技术在结核病诊断中的敏感性和特异性。我们认为，可以外推已知结核病病例的结果，以评估这些检测在诊断大量无法通过微生物确诊的结核病儿童中的潜在效用。儿童结核病(TB)的叙述性诊断，特别是在幼儿和艾滋病毒感染者中的诊断，受到缓慢、低效和昂贵方法的严重限制。我们的研究小组开发了新的结核病诊断工具和采集样本的方法，我们建议在埃塞俄比亚的幼儿中评估这些工具和方法，在那里，儿科结核病和艾滋病毒共同感染是主要问题。如果这些方法效果良好，它们可以允许临床医生针对儿童的特定感染进行快速治疗，从而提高结核病治疗的速度和结果。

DESCRIPTION (provided by applicant): NOVEL TECHNIQUES FOR THE DETECTION OF PEDIATRIC TB IN ETHIOPIA ABSTRACT Diagnosis of pediatric tuberculosis (TB) in resource-limited settings with high rates of HIV and TB is severely limited by methods that are slow, inefficient, and costly, which leads to increased morbidity and mortality. Our research team has made significant progress in the development of new TB diagnostic tools that demonstrate significant advantages over the gold standard diagnostics in adults. We propose to evaluate the potential of these new tools as well as others for the detection and direct susceptibility testing of Mycobacterium tuberculosis (Mtb) in children from 0-5 years of age. This project will be set in Ethiopia, where pediatric TB and HIV co- infection are major problems. We hypothesize that, compared to current standard techniques, the diagnosis of active TB in children and the recovery of Mtb isolates from these children can be done more quickly, efficiently, and cost-effectively using alternative clinical specimens in combination with more rapid diagnostic methods for both confirmation of TB and detection of drug resistance. If our hypothesis is correct, use of these methods will allow clinicians to institute rapid treatment directed specifically against the bacterial isolate from the infected child, improving the speed and outcome of anti-tuberculous therapy. To evaluate the potential utility of these techniques, we propose two studies. In the first study, we will evaluate the testing of various clinical specimens using innovative, inexpensive tests that may greatly facilitate the diagnosis of pediatric TB in developing countries with high rates of TB and HIV co-infection. The second study will include children with confirmed TB (identified in the first study) and healthy age-matched children. We will evaluate three immunologically-based techniques for their sensitivity and specificity in the diagnosis of TB disease. We believe the results in known TB cases can be extrapolated to assess the potential utility of these tests in the diagnosis of the large population of children with TB who are not able to have disease microbiologically confirmed. NARRATIVE Diagnosis of pediatric tuberculosis (TB), particularly among young children and those who are infected with HIV is severely limited by methods that are slow, inefficient, and costly. Our research team has developed new TB diagnostic tools and ways of collecting specimens and we are proposing to evaluate them in young children in Ethiopia where pediatric TB and HIV co infection are major problems. If these methods work well, they could allow clinicians to institute rapid treatment directed specifically against the child's particular infection, improving the speed and outcome of TB therapy.