Tuberculosis in childhood and adolescence: a view from different perspectives / Tuberculose na infância e adolescência: um olhar sob perspectivas diferentes

Abstract Objective To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention. Source of data Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor "Tuberculosis," delimited by type of study, period, age, and language. Synthesis of data In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug-resistant tuberculosis (2011-2016) was 0.5%. It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co-infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30 minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1-3) are ongoing, but no BCG-licensed substitute has been implemented yet. Conclusions There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis.

Resumo Objetivo Descrever a situação epidemiológica da tuberculose nos menores de 19 anos no Brasil e revisar as últimas publicações sobre risco de adoecimento, diagnóstico, tratamento e prevenção. Fonte dos dados Banco de notificação Brasil (2018), estimativas da Organização Mundial da Saúde e artigos do PubMed selecionados pelo descritor Tuberculosis, delimitaram-se tipo de estudo, período, idade e língua. Síntese dos dados Em 2018, no Brasil, 9,4% das notificações foram nos menores de 19 anos. Predominou a forma pulmonar em 80,1% dos casos. A taxa de cura foi de 76,8%, letalidade 0,8% e abandono 10,4%. A prevalência de tuberculose drogarresistente (2011 a 2016) foi 0,5%. Encontrou-se que o risco de adoecimento pode chegar até 56%, nos menores de cinco anos, influenciado por coinfecções com helmintos, malária, infecções virais crônicas, vacinas de vírus vivos atenuados e hipovitaminose D. A exposição ao doente bacilífero por períodos menores de 30 minutos é suficiente para o desenvolvimento de infecção e/ou doença. No Brasil, recomenda-se a pesquisa microbiológica, porém mantem-se o uso do Sistema de Pontuação, modificado em 2019. Estudos sobre detecção da infecção respaldaram o uso da prova tuberculínica. No tratamento, o grande avanço foi a introdução das formulações dispersíveis, adequação das doses preconizadas e esquemas encurtados para infecção latente. Vários estudos de vacinas (fases de 1 a 3) estão em andamento, mas ainda sem substituto licenciado para a BCG. Conclusões Observaram-se progressos no tratamento, porém ainda há grandes desafios para melhorar o diagnóstico, monitoramento e desfecho dos casos em busca da eliminação da tuberculose.

Tuberculosis in childhood and adolescence: a view from different perspectives.

OBJECTIVE: To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention. SOURCE OF DATA: Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor "Tuberculosis," delimited by type of study, period, age, and language. SYNTHESIS OF DATA: In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug-resistant tuberculosis (2011-2016) was 0.5%. It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co-infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1-3) are ongoing, but no BCG-licensed substitute has been implemented yet. CONCLUSIONS: There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis.

Peritonitis by Exophiala dermatitidis in a pediatric patient.

Fungal peritonitis is frequent on peritoneal dialysis, with rare cases by Exophiala dermatitidis. A 25-month-old female admitted to the pediatric ICU with acute renal failure was submitted to peritoneal dialysis. After 10 days patient presented fever. Peritoneal fluid culture showed yeast colonies molecularly identified as E. dermatitidis. Patient was treated with voriconazole and hemodialysis. The literature was reviewed. Disseminated infections are frequently fatal, but appropriate diagnose and therapeutic led to cure in this case.

Soroprevalência de hepatite A em crianças e adolescentes / Seroprevalence of hepatitis A in children and adolescents

OBJETIVOS: Avaliar a soroprevalência de hepatite A (VHA) em crianças e adolescentes com idade entre 1 e 14 anos, e identificar fatores associados à infecção prévia. MÉTODO: Estudo epidemiológico transversal, realizado entre fevereiro e agosto de 2006, em Curitiba, Paraná, Brasil, e em sua região metropolitana. A análise laboratorial constituiu-se de pesquisa qualitativa de anticorpos totais para o VHA em amostra de sangue total. RESULTADOS: No estudo, 901 crianças e adolescentes foram incluídos. A distribuição por faixa etária foi: 237 (26,3 por cento) entre 1 e 4 anos; 313 (34,7 por cento) entre 5 e 9 anos; e 351 (39 por cento) entre 10 e 14 anos. A taxa de soroprevalência geral encontrada foi de 19,8 por cento, e por grupo etário foi de 3, 21,1 e 29,9 por cento (p < 0,01), respectivamente. Na análise multivariada, demonstrou-se que os fatores que, em conjunto, mantiveram associação positiva com as prevalências de anticorpos contra o VHA na população estudada foram: faixa etária de 5 a 9 e 10 a 14 anos, morar em casas com um ou mais habitantes por cômodo, frequentar refeitório comunitário e ter baixa renda per capita. CONCLUSÕES: Os resultados demonstraram uma baixa prevalência de anticorpos contra o VHA, o que justifica o uso de medidas profiláticas, que incluem a vacinação precoce.

OBJECTIVES: To determine the seroprevalence of hepatitis A (HAV) in children and adolescents aged 1 to 14 years, and to identify factors associated with a history of infection. METHOD: This was a cross-sectional epidemiological study, conducted form February to August 2006 in the city of Curitiba, Paraná, Brazil, and the surrounding municipalities (Greater Curitiba). Laboratory analysis comprised qualitative assay for total HAV antibodies in whole blood samples. RESULTS: A total of 901 children and adolescents were recruited for the study. Age distribution was as follows: 1 to 4 years, n = 237 (26.3 percent); 5 to 9 years, n = 313 (34.7 percent); and 10 to 14 years, n = 351 (39 percent). The global rate of seroprevalence was 19.8 percent, and seroprevalence rates by age group were 3 percent, 21.1 percent and 29.9 percent respectively (p < 0.01). Multivariate analysis demonstrated that the following factors, in combination, had a positive association with the prevalence rate of antibodies against HAV in the study population: age groups 5 to 9 and 10 to 14 years, living in a household with more than one inhabitant per room, shared eating area and low per capita income. CONCLUSIONS: The results show a low prevalence of antibodies against HAV, which justifies the use of prophylactic measures, including early vaccination.

Seroprevalence of hepatitis A in children and adolescents.

OBJECTIVES: To determine the seroprevalence of hepatitis A (HAV) in children and adolescents aged 1 to 14 years, and to identify factors associated with a history of infection. METHODS: This was a cross-sectional epidemiological study, conducted form February to August 2006 in the city of Curitiba, Paraná, Brazil, and the surrounding municipalities (Greater Curitiba). Laboratory analysis comprised qualitative assay for total HAV antibodies in whole blood samples. RESULTS: A total of 901 children and adolescents were recruited for the study. Age distribution was as follows: 1 to 4 years, n = 237 (26.3%); 5 to 9 years, n = 313 (34.7%); and 10 to 14 years, n = 351 (39%). The global rate of seroprevalence was 19.8%, and seroprevalence rates by age group were 3%, 21.1% and 29.9% respectively (p < 0.01). Multivariate analysis demonstrated that the following factors, in combination, had a positive association with the prevalence rate of antibodies against HAV in the study population: age groups 5 to 9 and 10 to 14 years, living in a household with more than one inhabitant per room, shared eating area and low per capita income. CONCLUSIONS: The results show a low prevalence of antibodies against HAV, which justifies the use of prophylactic measures, including early vaccination.