Development and Evaluation of an NTM-IGRA to Guide Pediatric Lymphadenitis Diagnosis.

BACKGROUND: Diagnosis of nontuberculous mycobacteria (NTM) infections remains a challenge. In this study, we describe the evaluation of an immunological NTM-interferon (IFN)-γ release assay (IGRA) that we developed using glycopeptidolipids (GPLs) as NTM-specific antigens. METHODS: We tested the NTM-IGRA in 99 samples from pediatric patients. Seventy-five were patients with lymphadenitis: 25 were NTM confirmed, 45 were of unknown etiology but compatible with mycobacterial infection and 5 had lymphadenitis caused by an etiologic agent other than NTM. The remaining 24 samples were from control individuals without lymphadenitis (latently infected with M. tuberculosis , uninfected controls and active tuberculosis patients). Peripheral blood mononuclear cells were stimulated overnight with GPLs. Detection of IFN-γ producing cells was evaluated by enzyme-linked immunospot assay. RESULTS: NTM culture-confirmed lymphadenitis patient samples had a significantly higher response to GPLs than the patients with lymphadenitis of unknown etiology but compatible with mycobacterial infection ( P < 0.001) and lymphadenitis not caused by NTM ( P < 0.01). We analyzed the response against GPLs in samples from unknown etiology lymphadenitis but compatible with mycobacterial infection cases according to the tuberculin skin test (TST) response, and although not statistically significant, those with a TST ≥5 mm had a higher response to GPLs when compared with the TST <5 mm group. CONCLUSIONS: Stimulation with GPLs yielded promising results in detecting NTM infection in pediatric patients with lymphadenitis. Our results indicate that the test could be useful to guide the diagnosis of pediatric lymphadenitis. This new NTM-IGRA could improve the clinical handling of NTM-infected patients and avoid unnecessary misdiagnosis and treatments.

Prevalence and Clinical Characteristics of Children With Nonsevere Tuberculosis in Spain.

BACKGROUND: To assess the prevalence and characteristics of nonsevere TB among children in Spain. It has been recently demonstrated that these children can be treated with a 4-month regimen instead of the classical 6-month treatment regimen, with the same effectivity and outcomes, decreasing toxicity and improving adherence. METHODS: We conducted a retrospective cohort study in a cohort of children ≤16 years of age with TB. Nonsevere TB cases included smear-negative children with respiratory TB confined to 1 lobe, with no significant airway obstruction, no complex pleural effusion, no cavities and no signs of miliary disease, or with peripheral lymph-node disease. The remaining children were considered to have severe TB. We estimated the prevalence of nonsevere TB and compared the clinical characteristics and outcomes between children with nonsevere and severe TB. RESULTS: A total of 780 patients were included [46.9% males, median age 5.5 years (IQR: 2.6-11.1)], 477 (61.1%) of whom had nonsevere TB. Nonsevere TB was less frequent in children <1 year (33% vs 67%; P < 0.001), and >14 years of age (35% vs 65%; P = 0.002), mostly diagnosed in contact tracing studies (60.4% vs 29.2%; P < 0.001) and more frequently asymptomatic (38.3% vs 17.7%; P < 0.001). TB confirmation in nonsevere disease was less frequent by culture (27.0% vs 57.1%; P < 0.001) and by molecular tests (18.2% vs 48.8%; P < 0.001). Sequelae were less frequent in children with nonsevere disease (1.7 vs 5.4%; P < 0.001). No child with nonsevere disease died. CONCLUSIONS: Two-thirds of children had nonsevere TB, mostly with benign clinical presentation and negative microbiologic results. In low-burden countries, most children with TB might benefit from short-course regimens.

Diagnòstic retrospectiu d'infecció congènita per citomegalovirus per PCR de prova del taló / Diagnóstico retrospectivo de infección congénita por citomegalovirus por PCR de prueba de talón / Retrospective diagnosis of congenital cytomegalovirus infection

Introducció: el citomegalovirus (CMV) és el principal agent infecciós causant de morbimortalitat infantil d'origen congènit en els països desenvolupats, amb una prevalença d'entre el 0,3 i el 2,4% dels nounats. La presentació clí-nica en el nounat és variable, i en la majoria dels casos és asimptomàtic. Quan la sospita diagnòstica es planteja més enllà dels 15 dies de vida cal fer diagnòstic diferencial amb formes postnatals. S'ha assajat la detecció de citomegalovirus mitjançant tècniques de reacció en cadena de la polimerasa (PCR) en la mostra de sang seca en el paper utilitzat per a la prova de detecció precoç dels nadons. Cas clínic: el primer cas és una lactant de 8 mesos amb microcefàlia detectada als 6 mesos de vida, associada a retard psicomotor global i pobra resposta auditiva. El segon cas és una lactant de 4 mesos derivada per estancament del perímetre cranial. En l'exploració destaca un pobre seguiment visual i hipotonia. En totes dues pacients es va practicar RM cerebral i es van detectar troballes compati-bles amb infecció congènita per citomegalovirus. Es va sol•licitar la mostra de sang seca per fer la determinació de PCR de citomegalovirus i es va confirmar el diagnòstic. Comentaris: la infecció congènita per CMV continua pre-sentant grans interrogants. A Espanya no es fa cribratge serològic sistemàtic per CMV durant l'embaràs. L'únic mètode per distingir entre infecció congènita o adquirida més enllà de les dues setmanes de vida és la realització de PCR per citomegalovirus en la sang utilitzada per la prova del taló

Introducción. El citomegalovirus (CMV) es el principal agente infeccioso causante de morbimortalidad infantil de origen congénito en los países desarrollados, con una prevalencia de entre el 0,3% y el 2,4% de los recién nacidos. La presentación clínica en el recién nacido es variable, y en la mayoría de los casos es asintomático. Cuando la sospecha diagnóstica se plantea más allá de los 15 días de vida hay que hacer diagnóstico diferencial con formas postnatales. Se ha ensayado la detección de citomegalovirus mediante técnicas de reacción en cadena de la polimerasa (PCR) en la muestra de sangre seca en el papel utilizado para la prueba de detección precoz de los recién nacidos. Caso clínico. El primer caso es una lactante de 8 meses con microcefalia detectada a los 6 meses de vida, asociada a retraso psicomotor global y pobre respuesta auditiva. El segundo caso es una lactante de 4 meses derivada por estancamiento del perímetro craneal. En la exploración destaca un pobre seguimiento visual e hipotonía. En ambas pacientes se practicó RM cerebral y se detectaron hallazgos compatibles con infección congénita por citomegalovirus. Se solicitó la muestra de sangre seca para realizar la determinación de PCR de citomegalovirus y se confirmó el diagnóstico. Comentarios. La infección congénita por CMV sigue presentando grandes interrogantes. En España no se realiza cribado serológico sistemático por CMV durante el embarazo. El único método para distinguir entre infección congénita o adquirida más allá de las dos semanas de vida es la realización de PCR por citomegalovirus en la sangre utilizada para la prueba del talón (AU)

Introduction. Cytomegalovirus (CMV) is the leading infectious agent causing congenital infant morbidity and mortality in developed countries, with an estimated prevalence of 0.3% to 2.4% of newborns. The clinical presentation in the newborn is variable, although it is asymptomatic in most cases. When the diagnosis is suspected beyond 15 days of life it is necessary to consider a differential diagnosis with postnatal forms. Detection of CMV DNA by polymerase chain reaction (PCR) of dry blood spots collected for routine neonatal screening from all newborns has been proposed for congenital CMV infection screening. Case report. The first case is an eight months old infant with microcephaly detected at 6 months of life associated with poor auditory response and psychomotor retardation. The second case is a 4 months old infant with stagnation of head circumference. Examination revealed poor visual tracking and hypotonia. In both patients brain MRI disclosed typical alterations associated with congenital CMV infection. Dried blood sample obtained from heel stick at birth was used for determination of CMV infection by PCR. Comments. Congenital CMV infection continues to present major challenges. In Spain no systematic serological screening of CMV is performed during pregnancy. The only method for distinguishing between congenital or acquired infection beyond the two weeks of life is the PCR test using dry blood obtained for newborn screening (AU)

Nen de 3 anys amb tumoració supraclavicular / No disponible

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