Archives of Pediatric Infectious Diseases
Volume:3 Issue: 1, Jan 2015

There is limited data on outcomes of adolescents with drug-resistant tuberculosis (DR-TB).. To describe patient outcomes and factors associated with outcomes of adolescents diagnosed with DR-TB in Khayelitsha, South Africa..Patients and A retrospective analysis of data for adolescents aged 10-19 years who were diagnosed with DR-TB between January 2008 and August 2013 was conducted. The proportions of adolescents with treatment success (cure and treatment completion), failure of treatment, those lost from treatment, and those who died were calculated and compared by HIV status. Proportions and odd ratios are presented.. Seventy-one adolescents were diagnosed with DR-TB. Six (8%) were lost to care before treatment could be initiated. The median age of those started on treatment was 18 years (IQR 15.8-18.9). Eighteen (27.7%) were HIV infected. Of the 44 adolescents with final treatment outcomes, 36.4% (n = 16) were successfully treated, 9.1% (n = 4) died, 11.4% (n = 9) failed treatment and 43.2% (n = 19) were lost from treatment (treatment interrupted for ≥ 2 consecutive months). Three of the four patients who died, died within two months of starting therapy. Loss from treatment, and treatment success (cure or treatment completion) did not differ between HIV infected and un-infected adolescents, OR: 2.0, (95% CI 0.56-7.50), P = 0.27; and OR: 1.2 (95% CI 0.37-4.43), P = 0.71, respectively. All five patients who failed treatment and one of those lost from treatment subsequently died. Overall mortality was 12.1/100 person years.. HIV infected and uninfected adolescents with DR-TB experienced poor outcomes with high proportions of mortality, treatment failure and loss from treatment. Mortality occurred early in the treatment period suggesting delayed presentation and/or diagnosis. Innovative and targeted strategies are needed to encourage early presentation and improve adherence to treatment among adolescents..

Context: Tuberculosis (TB) disease caused by Mycobacterium tuberculosis (Mtb) remains as one of the leading infectious causes of death and disease throughout the world. The history of tuberculosis as a worldwide fatal illness traces back to antiquity, being a well-known disease in ancient civilizations.. Evidence Acquisition: Presented here, is a brief review of the history of tuberculosis and Bacillus Calmette–Guérin (BCG) vaccine development in the world as well as its historical background in Iran, mainly during the 19th and 20th centuries using a wide range of published information sources until the last months of 2013.. TB causative agent remained unidentified until the last decade of the 19th century, when Robert Koch discovered it. At present, preparation of the BCG vaccine, application of the Mantoux intradermal diagnostic tuberculosis test and administration of proper antituberculosis medications have eventually controlled tuberculosis.. However, despite these significant advancements, tuberculosis remains a major concern, particularly in developing countries including Iran after the emergence of both multidrug-resistant tuberculosis and HIV co-infection..

Bacillus Calmette-Guérin (BCG) vaccine, a live attenuated Mycobacterium bovis strain, is administrated to all newborn infants in endemic regions according to the current World Health Organization (WHO) recommendation.. We report a 10-month-boy who was a known case of severe combined immunodeficiency (SCID) admitted with multi-focal fusiform painful swelling in his hands. He had undergone bone marrow transplantation 7 weeks before admission. Multidisciplinary management was done to treat this rare post-transplant occurrence of Bacillus Calmette-Guérin complication.. BCG vaccination administrated routinely in Iran, given that of no screening program for primary immune deficiency currently achieved in our country, exact attention to reschedule of immunization programs in suspicious newborn (with primary immune deficiency) always is necessary and is one of the most effective strategy to prevent BCG complication..

BCG (Bacille Calmette-Guerin) vaccine is an attenuated live vaccine administered to prevent Tuberculosis. Disseminated infection due to BCG is a rare life threatening complication of this vaccine, especially in immunocompromised patients.. The current study evaluated the sensitivity pattern of the BCG strain supplied by the Institute de Pasteur, Iran against anti-mycobacterial drugs used to treat disseminated infection caused by the vaccine..Patients and Materials: Bacille Calmette-Guerin strain ATCC 1173 P was purchased from the Pasteur Institute in Tehran and three samples of Mycobacterium bovis isolated from subaxillary adenitis of three patients were tested for susceptibility to major anti-mycobacterial drugs by MODS (microscopic observation drug sensitivity) method.. All samples of BCG strain were resistant to most of the anti-mycobacterial drugs used separately except for concentrations of isoniazid 1 µg/mL, ethambutol 3 µg/mL, ciprofloxacin 4 µg/mL and clarithromycin 2 µg/mL. Addition of pyrazinamide (PZA) 25 µg/mL, the susceptibility pattern did not change to any drug, but increasing PZA concentration to 50 µg/ml and combining it with ethionamide 2 µg/mL, isoniazid 0.2 µg/mL, streptomycin 2 µg/mL, rifampin 0.5 µg/mL or ciprofloxacin 0.2 µg/mL, made the Mycobacterium strains susceptible.. The current study findings revealed that Mycobacterium bovis resistance to pyrazinamide is resolved by increasing the concentration of the drug and combining PZA with other anti-mycobacterial agents..

Medicinal plants have been used traditionally in Golestan province (north of Iran), against Mycobacterium tuberculosis or the clinical signs of tuberculosis (TB).. This study aimed to define the inhibitory effects of ethanolic extracts of six of these medicinal plants against Mycobacterium tuberculosis.. Peganum harmala (seed extract), Punica granatum (peel extract), Digitalis sp. (leaf extract), fruit extract of Citrus lemon, Rosa canina and Berberis vulgaris were extracted in ethanol and their activity against M. tuberculosis isolates were determined by the agar diffusion method. The zone of inhibition (at 200 to 1.6 mg/mL) was measured and the results were compared with isoniazid and rifampin as standard positive controls. Also the concentration of vitamin C of each the extracts was evaluated.. The ethanolic extract of Peganum harmala seed and Punica granatum peel exhibited potential activity against all M. tuberculosis isolates with mean inhibitory zone of 18.7 and 18.8 mm, at 200 mg/mL concentration. The mean inhibitory zone around isoniazid and rifampinwere 19.2 and 18.8 mm. Ethanolic extract of Citrus lemon showed moderate inhibitory activity only against sensitive (non MDR; non multi drug resistant) strains of M. tuberculosis, and Digitalis sp. showed inhibitory effects on five isolates. Ascorbic acid content was 43.3 mg/dL in Punica granatum and Digitalis sp. and only 9.1 mg/dL in ethanolic extract of Peganum harmala.. The highest content of vitamin C was observed in the extract of Punica granatum, which was observed to be highly active against Mycobacterium tuberculosis, while the P. harmala must have contained other phytochemical constituents that contributed to the anti-tuberculosis effects of this plant. Our findings showed that ethanolic extracts of P. granatum and P. harmala had anti-TB effects comparable to isoniazid and rifampin and can be good candidates for novel and safe natural products against tuberculosis..

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are increasing globally. Treatment options for these patients are very limited. Although treatment of these patients with standardized regimen is associated with high mortality and morbidity, rational usage of new drugs might be promising. In this study we will review epidemiology of XDR-TB and TDR-TB in Iran and the world..

Context: It has been estimated that one-third of the world’s population are suffering from latent tuberculosis infection (LTBI). In order to control tuberculosis in high-risk groups proper diagnosis and treatment is essential..Evidence Acquisition: Useless and expensive tests such as unfocused population-based tests can lead to futile and unnecessary treatments. Targeted screening approaches and individualization of LTBI treatment protocols must be a priority.. Diagnostic methods with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) can accurately detect LTBI. However, interferon-gamma release assays have higher specificity than TST in Bacille Camette-Gurin (BCG)-vaccinated populations; both tests are precise to identify latent tuberculosis. However, it is of great concern that both tests have insignificant roles in predicting risk of progression to active tuberculosis.. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for the comparison of these tests..

Kikuchi-Fujimoto disease (KFD) is an uncommon idiopathic self-limited cause of lymphadenitis that most commonly presents with cervical lymphadenopathy with or without systemic signs and symptom, which is also called histiocytic necrotizing lymphadenitis (1-6). Although infection and autoimmune etiology have been suggested, the cause of KFD is unknown. Several features that support a role for an infectious cause include the generally self-limited courses and association with symptoms similar to upper respiratory tract infection. Many viral infections have been proposed including cytomegalovirus, varicella zoster virus, human herpes virus, Epstein-Barr virus, parainfluenza virus, parvovirus B19, paramyxovirus, Yersinia enterocolitica, and Toxoplasma gondii. In a Korean study on 147 patients presenting at an outpatient clinic, KFD (34.7%) and tuberculous (TB) adenitis (22.4%) were the most common causes of cervical adenitis (7-14).. We presented a case of TB lymphadenitis in association with celiac disease that mimicked KFD in a young child.. Celiac disease, also known as gluten-sensitive enteropathy and nontropical sprue, is an autoimmune disease with chronic inflammation of small intestine, which is associated with increased risk of TB infection. TB lymphadenitis can mimic KFD. Therefore, in each case of unusual lymphadenitis, TB should be considered and if it is associated with failure to thrive, celiac disease should be suspected..