To evaluate an interferon (IFN)-gamma release assay in diagnosing latent tuberculosis infection in pregnant adolescents and women at risk for exposure to Mycobacterium tuberculosis.
This was a ...prospective study of women and adolescents receiving health care at Bellevue Hospital Outpatient Clinics in New York City. Each patient was assessed for M tuberculosis risk factors, had a tuberculin skin test placed, and an IFN-gamma release assay performed. The concordance between the tuberculin skin test and the IFN-gamma release assay was calculated and the results analyzed according to the likelihood of exposure to M tuberculosis. Mean mitogen IFN-γ levels were used across groups to compare reliability between trimesters and assay performance in pregnant compared with nonpregnant females of childbearing age.
A total of 140 pregnant and 140 nonpregnant females were enrolled in the study. The IFN-gamma release assay was highly specific, and IFN-gamma release assay positivity was associated with a greater likelihood of exposure to M tuberculosis. The overall agreement between the tuberculin skin test and IFN-gamma release assay results was 88% for all pregnant patients, corresponding to a κ of 0.452 (confidence interval 0.26-0.64). Interferon-γ release from the mitogen did not appear to have any temporal association with pregnancy trimester in cross-sectional or longitudinal studies. The IFN-gamma release assay performed equally well in pregnant and nonpregnant females.
The IFN-gamma release assay performed equally well in each trimester of pregnancy with comparable results to nonpregnant females. Interferon-gamma release assays are much more specific, at least as sensitive, and may be a better predictor of disease progression than the tuberculin skin test.
: II.
There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in ...children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis.
Following a major rainstorm in the northeast United States, Infection Preventionists (IPs) played key roles in the recovery efforts to restore normal and safe clinical operations at a major academic ...medical center. Additionally, several hundred patients, including those on isolation precaution, had to be emergently evacuated and transferred to surrounding hospitals.
Recent data suggest that interferon-gamma release assays may have reduced sensitivity in children.
To explore the cellular responses in children infected with tuberculosis (TB) to different ...mycobacterial antigens, including the peptides used in the QuantiFERON®-TB Gold In-Tube (QFT) assay.
Cytokines were measured by multiplex analyte detection in supernatants after stimulation with peptides in QFT, purified protein derivative (PPD) and recombinant whole protein ESAT-6. Samples from 11 children with active TB, 46 healthy children with latent tuberculosis infection (LTBI), and 35 healthy non-infected children were analyzed.
None of the cytokines examined in the QFT peptide stimulation assay distinguished between non-infected children and those aged <5 years with LTBI. Cytokines interleukin-2 and transforming growth factor-beta 1 (TGF-β1) were shown to distinguish between stages of Mycobacterium tuberculosis infection after blood was stimulated with the QFT peptides. All children had significantly higher Th 1 and 2 cytokine production against PPD than against the other antigens tested.
Measuring specific cytokine patterns after stimulation with the QFT peptides may not increase sensitivity in diagnosing LTBI in children, but there may be future diagnostic value in determining the stage of infection. PPD-stimulated blood produced a robust and diverse cytokine response in young children, making it an interesting antigen for in vitro diagnostic studies.
We present the first case of pediatric intracranial Mycobacterium abscessus infection in a 16-month-old female with neurofibromatosis type 1. We describe a successful treatment regimen including ...excisional biopsy combined with high-dose steroids and 16 weeks of triple antimicrobial therapy that resulted in clinical cure and an excellent neurologic outcome.
Abstract Purpose Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI ...processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Methods Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Results Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Conclusion Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies.
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection that can lead to significant morbidity and mortality in immunocompromised pediatric hematology/oncology patients. ...Trimethoprim/sulfamethoxazole is the gold standard for prophylaxis. Intravenous (IV) pentamidine is the preferred second-line agent for PCP prophylaxis at our institution and is used first-line under certain circumstances. The purpose of this study is to evaluate the effectiveness and safety of IV pentamidine for PCP prophylaxis in pediatric hematology/oncology patients.
A retrospective analysis of pediatric hematology/oncology patients (N=121) who received ≥1 dose of IV pentamidine between January 2009 and July 2014 was conducted. Electronic health records were reviewed to determine baseline characteristics, rate of breakthrough PCP infection, characteristics of IV pentamidine use, and adverse events. The follow-up period was 6 months after the last reported IV pentamidine dose or the last recorded clinic visit/hospital admission.
No patients developed PCP during the entirety of their IV pentamidine course or during the follow-up period. Nineteen patients (16%) experienced adverse events and 5 of the 19 patients required discontinuation of IV pentamidine.
IV pentamidine is a safe, tolerable, and effective agent for PCP prophylaxis in pediatric hematology/oncology patients and may be considered a reasonable therapeutic alternative when trimethoprim/sulfamethoxazole cannot be used for PCP prophylaxis.
Early-life exposures to microbes, coupled with genetically determined susceptibility, have an impact on the natural history of childhood asthma. We hypothesized that childhood infection with
...Mycobacteria tuberculosis,
a bacterium that has infected
Homo sapiens
for close to millennia, may be relevant to the risk of asthma development. The aim of this study was to evaluate any associations between tuberculosis infection with asthma and allergies using the cross-sectional and the U.S. nationally representative 1999–2000 National Health and Nutrition Examination Survey. Adjusted odds ratios (ORs) for having a history of asthma, allergic rhinitis, or atopic allergic symptoms were compared to evidence of tuberculosis infection as determined by the presence of tuberculin skin test results of 10 mm or greater. Children <20 years of age infected with tuberculosis were significantly less likely to have a history of asthma OR 0.2; 95% confidence interval (CI): 0.0–0.9 or symptoms of asthma over the prior year (OR 0.1; 95% CI: 0.0–0.5) than children not infected with tuberculosis. This finding was not confounded by bacille Calmette-Guerin vaccination. Tuberculosis infection is associated with a substantially decreased risk of asthma in children. This finding is consistent with the hygiene hypothesis, which suggests that microbes that co-evolved with humans may influence developing immune systems in ways that have a protective effect against the development of asthma.
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