Accuracy of Xpert Ultra for the diagnosis of paediatric tuberculosis in a low TB burden country: a prospective multicentre study.

INTRODUCTION: Childhood pulmonary tuberculosis (TB) remains a diagnostic challenge. This study aimed to evaluate the performance of Xpert Ultra for the diagnosis of pulmonary TB in children in a low TB prevalence setting. METHODS: Prospective, multicentre, diagnostic accuracy study. Children with clinical or radiological suspicion of pulmonary TB were recruited at 11 paediatric units in Spain. Up to three gastric or sputum specimens were taken on 3 consecutive days, and analysed by Xpert MTB/RIF, Xpert Ultra and culture in parallel. RESULTS: 86 children were included (median age 4.9 years, IQR 2.0-10.0; 51.2% male). The final diagnosis was pulmonary TB in 75 patients (87.2%); 33 (44.0%) were microbiologically confirmed. A total of 219 specimens, comprising gastric aspirates (n=194; 88.6%) and sputum specimens (n=25; 11.4%), were analysed. Using culture as reference standard and comparing individual specimens, the sensitivity was 37.8% (14/37) for Xpert MTB/RIF and 81.1% (30/37) for Xpert Ultra (p<0.001); specificity was 98.4% (179/182) and 93.4% (170/182), respectively (p=0.02). In the per-patient analysis, considering positive results on any specimen, the sensitivity was 42.9% (9/21) for Xpert MTB/RIF and 81.0% for Xpert Ultra (17/21, p=0.01); specificity was 96.9% (63/65) and 87.7% (57/65, p=0.07), respectively. CONCLUSIONS: In children with pulmonary TB in a low burden setting, Xpert Ultra has significantly higher sensitivity than the previous generation of Xpert assay and only marginally lower specificity. Therefore, in children undergoing evaluation for suspected pulmonary TB, Xpert Ultra should be used in preference to Xpert MTB/RIF whenever possible.

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.

Clinical Presentations and Outcomes Related to Tuberculosis in Children Younger Than 2 Years of Age in Catalonia.

Introduction: Children younger than 2 years have an increased risk of complications associated with tuberculosis (TB) due to the immaturity of the innate and adaptive immune response. We aimed to identify TB clinical presentations and outcomes as well as risk factors for complications in this age group. Materials and Methods: Multicenter, retrospective, cross-sectional study of TB cases in children aged <2 years in Catalonia (2005-2013). Epidemiological and clinical data were collected from the hospital medical records. TB complications, sequelae included, were defined as any tissue damage generating functional or anatomical impairment after being diagnosed or after TB treatment being completed. Statistical analyses were based on bivariate chi-square and multivariate logistic regression, and it was carried out with Stata® version 13.1. Odds ratios (OR) and its 95% confidence intervals were calculated (CI). Results: A total of 134 patients were included, 50.7% were male, the median [IQR] age was 13[8-18] months, and 18.7% (25/134) showed TB-associated complications. Pulmonary TB was diagnosed in 94.0% (126/134) of children, and the most common complications were lobar collapse (6/126). TB meningitis was diagnosed in 14/134 (10.4%), and hydrocephalus and mental impairment occurred in 1 and 2 patients, respectively. Two patients with spinal TB developed vertebral destruction and paraplegia, respectively. Only one of the patients died. At multivariate level, tachypnea (OR = 4.24; 95% CI 1.17-15.35) and meningeal (OR = 52.21; 95% CI 10.05-271.2) or combined/extrapulmonary forms (OR = 11.3; 95% CI 2.85-45.1) were associated with the development of TB complications. Discussion: TB complications are common in children under 2 years old. Extrapulmonary TB forms in this pediatric age remain a challenge and require prompt diagnosis and treatment in order to prevent them. The presence of tachypnea at the time of TB diagnosis is an independent associated factor to the development of TB complications in infants. This clinical sign should be closely monitored in patients in this age group. It is necessary to perform further studies in this age group in a prospective design in order to understand whether there are other factors associated to TB complications.

Pregnancy as an opportunity to diagnose human-immunodeficiency virus immigrant women in Catalonia. / El embarazo como una oportunidad de diagnóstico del virus de la inmunodeficiencia humana en mujeres inmigrantes en Catalunya.

INTRODUCTION: Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. METHODS: A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. RESULTS: The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). CONCLUSIONS: There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women.

El embarazo como una oportunidad de diagnóstico del virus de la inmunodeficiencia humana en mujeres inmigrantes en Catalunya / Pregnancy as an opportunity to diagnose human-immunodeficiency virus immigrant women in Catalonia

Introducción: La transmisión vertical (TV) es relevante en la epidemiología global del virus de la inmunodeficiencia humana (VIH), representando la principal vía de infección en la edad pediátrica. Los objetivos del estudio fueron determinar la tasa de TV del VIH y su tendencia epidemiológica entre la población autóctona e inmigrante en Catalunya entre 2000-2014. Métodos: Estudio observacional prospectivo de parejas madre-hijo expuestas al VIH atendidas en 12 hospitales de Catalunya en 2000-2014. Se estimó la tasa de TV del VIH aplicando un modelo bayesiano de regresión logística. Se utilizó el software estadístico R y WinBUGS. Resultados: Se analizaron 909 gestantes, 1.009 embarazos y 1.032 niños; datos de origen materno en el 79,4% de las mujeres, el 32,7% inmigrantes y de estas el 53,0% de África subsahariana. La tasa de TV del VIH fue del 1,4% (14/1.023; IC95% 0,8-2,3). El riesgo de TV del VIH fue 10 veces menor en mujeres con buen control virológico (p=0,01), al que llegaron 2 tercios de ellas. No hubo diferencias en la tasa de TV del VIH entre mujeres autóctonas e inmigrantes (p=0,6). La proporción de mujeres inmigrantes fue significativamente mayor en el período 2008-2014 (p<0,0001), en relación con el diagnóstico de la infección por VIH (p<0,0001) y la administración de antirretrovirales (p=0,02) durante el embarazo, y con la viremia indetectable próxima al parto (p<0,001). Conclusiones: Existe un aumento progresivo de gestantes inmigrantes con VIH en Catalunya. Aun siendo la mayoría diagnosticadas durante el embarazo, la tasa de TV del VIH no fue diferente a la hallada en las mujeres autóctonas (AU)

Introduction: Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. Methods: A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. Results: The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). Conclusions: There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women (AU)

Retrobament amb la febre tifoide a Catalunya al segle XXI. Comentaris clínics i al tractament / No disponible

Fonament. La febre tifoide va ser una malaltia freqüental nostre país fins a la dècada dels vuitanta del segle XX. En l’actualitat el pediatre no està acostumat al diagnòstic clínic d’aquesta malaltia.Objectiu. Revisar els casos diagnosticats els darrers 6anys, a la vegada que revisar els aspectes més actuals de la malaltia i el seu tractamentMètode. Revisió retrospectiva dels casos diagnosticatsdurant el segle XXI amb l’anàlisi demogràfica, epidemiològica i clínica, les dades de laboratori, l’evolució i el tractamentResultats. S’han diagnosticat 10 casos entre el 2002-2006, només 2 van ser d’infants autòctons; els altres, excepte 1, havien arribat a Catalunya entre 2 i 15 dies abans. La febre, únic símptoma present en tots els casos, s’havia instaurat entre 3 i 15 dies abans. El diagnòstic es va fer per la positivitat de l’hemocultiu. Els microorganismes aïllats en 2 casos presentavenresistències. Es van tractar amb cefalosporines de3a generació iv o orals en 8 casos, 1 amb amoxicil·lina -àcid clavulànic i 1 amb azitromicina. L’apirèxia es va presentar entre els 3 i 15 dies amb una mitjana de 6.3 dies.Les complicacions, amb bona evolució: 4 hepatitis, 3 colecistitis alitiàsica, 1 coagulopatia, anèmia (que va necessitar transfusió) i pancreatitis. 1 recaiguda als 15 dies.Conclusions. a) El fet que en cap cas es pensa clínicament en aquest diagnòstic, excepte en la recaiguda. b) L’ajut que ofereix l’ecografia en el seguiment de possibles complicacions abdominals. c) L’actualització dels tractaments

No disponible

Programa d’interconsulta psicològica entre el Centre de Salut Mental Infantil i Juvenil de Lleida i el Servei de Pediatria de l’Hospital Universitari Arnau de Vilanova (1996-2002) / Programa de interconsulta entre el Centro de Salut Mental de Lleida y el Servicio de Pediatría del Hospital Universitario Arnau de Vilanova (1996-2002) / A program of effective psychology referral between the Center of Pediatric and Adolescent Mental Health of Lleida and the division of pediatrics of the Hospital Universitari Arnau de Vilanova of Lleida (1996-2002)

Objectiu. Evitar el perllongament innecessari dels ingressos, disminuir les ansietats dels pares que poden allargar de manera innecessària els ingressos i/o la correcta aplicació del tractament mèdic, i agilitar la derivació als recursos de la xarxa de salut mental en el cas de detectar un trastorn psiquiàtric. Mètode. Interconsulta amb el pediatre responsable del pacient, entrevista diagnòstica amb la família i l’infant, proves diagnòstiques gràfiques i interconsulta amb el pediatre per comentar el cribratge diagnòstic i la proposta d’intervenció. Resultats. Es van fer un total de 1.104 consultes (44.85% nois i 55.15% noies). L’edat majoritària va ser de 11-14 anys (34.4% nois, 49.7% noies). Les interconsultes més freqüents van ser per diabetis mellitus tipus I (DMID) (30.4% total), àlgies (28.4% total), trastorns del comportament alimentari (TCA) (11.3% noies) i accidents (7.4% nois). El diagnòstic més freqüent va ser de trastorns neurò- tics (44.1% total; ansietat: 24.6% nois; histèria: 17.3% noies, i depressió: 11.3% noies) i de trastorns reactius (27.2% total). Es van derivar al CSMIJ de Lleida el 54.9% dels nois i el 44.6% de les noies. Conclusions. Majoritàriament, les famílies i els pacients van col•laborar en el cribratge, facilitant la discriminació ràpida i interdisciplinària dels aspectes psicosomàtics i la detecció de trastorns psiquiàtrics. S’han evitat perllongaments innecessaris dels ingressos. Ha facilitat el treball en xarxa dels diferents dispositius relacionats amb la infància i l’adolescència (AU)

Objetivo. Evitar la prolongación innecesaria de los ingresos, disminuir las ansiedades de los padres que pueden prolongar innecesariamente los ingresos y/o la correcta aplicación del tratamiento médico y agilizar la derivación a los recursos de la red infantil de salud mental en el caso de detectar un trastorno psiquiátrico. Método. Interconsulta con el pediatra responsable del paciente, entrevista diagnostica con la familia y con el niño, pruebas gráficas e interconsulta con el pediatra para comentar la cribación diagnóstica y la propuesta de intervención. Resultados. Se hicieron un total de 1.104 consultas (44.85% chicos y 55.15% chicas). La edad mayoritaria fue de 11-14 años (34.4% chicos, 49.7% chicas). Las interconsultas más frecuentes fueron por diabetes mellitus I (DMID) (30.4% total), algias (28.4% total), trastornos del comportamiento alimentario (11.3% chicas) y accidentes (7.4% chicos). El diagnóstico más frecuente fue de trastornos neuróticos (44.1% total: ansiedad, 24.6% chicos; histeria, 17.3% chicas, y depresión, 11.3% chicas) y de trastornos reactivos (27.2% total). Se derivaron al CSMIJ de Lleida 54.9% chicos y 44.6% chicas. Conclusiones. Mayoritariamente las familias y pacientes han colaborado en la cribación diagnóstica, esto ha facilitado la discriminación rápida e interdisciplinar de los aspectos psicosomáticos y la detección de trastornos psiquiátricos. Se han evitado prolongaciones innecesarias de ingresos. Ha facilitado el trabajo en red de los distintos dispositivos relacionados con la infancia y la adolescencia (AU)

Objectives. To avoid unnecessary prolongation of hospital admissions, decrease the parental anxiety that may interfere with the appropriate medical management or delay discharges, and to expedite the referral to the network of pediatric mental health once a psychiatric disturbance is detected. Methods. Consultation with the primary pediatrician, diagnostic interview with the child and the family, diagnostic tests, and discussion of diagnostic possibilities and proposed intervention with the primary pediatrician. Results. Between May 1996 and December 2003, 1,104 children (45% boys, 55% girls) were evaluated. The most common age group was 11 to 14 years (34% of the boys, 50% of the girls). The most common reasons for consultation were insulin-dependent diabetes mellitus (IDDM) (30.4%), nonspecific pain (28.4%), eating disorders (11.3% of girls), and accidents (7.4% of boys). The most common diagnosis was neurosis (44.1% total; anxiety, 24.6% boys; hysteria, 17.3% girls, and depression, 11.3% girls), and reactive disorders (27.2% of the total). 55% of the boys, and 45% of the girls were referred to the CSMIJ of Lleida. Conclusions. The families and the patients have been very cooperative during the diagnostic process, which has facilitated the rapid triage and detection of psychosomatic and psychiatric disorders. This has resulted in the avoidance of unnecessary prolongations of hospital admissions, and facilitated the multidisciplinary work within our network (AU)