Tuberculosis: Children hospitalized with severe pneumonia in high-incidence countries should be screened for tuberculosis Press room
In countries with a high incidence of tuberculosis, the disease can cause severe pneumonia in children and can lead to death in the youngest of them. © TB-Speed
Tuberculosis affects 1 million children each year, less than half of whom are diagnosed and treated, resulting in over 200,000 deaths each year. In a new study, researchers and clinicians from the University of Bordeaux, the Inserm Development Research Institute (IRD) and MU-JHU (a research collaboration between Makerere University in Uganda and Johns Hopkins University) have been grouped into the TB-Speed framework. the consortium showed that admission screening for tuberculosis of children with severe pneumonia is feasible.
Moreover, such screening with a test called Xpert Ultra will improve the diagnosis of tuberculosis in children in countries with a high incidence of the disease. The results of the study are in favor of more systematic use of Xpert Ultra in these children, especially those suffering from acute malnutrition. Finally, they confirm the importance of tuberculosis as a cause of severe pneumonia in children. Results published from 15 November 2022 Lancet Infectious Diseases.
In countries with a high incidence of tuberculosis, the disease can cause severe pneumonia in children and can lead to death in the youngest of them. As a rule, the diagnosis of tuberculosis is considered only in children with long-lasting symptoms, in those who have failed one or more antibiotic treatments for community-acquired pneumonia, or in those who have been in contact with a sick person. Thus, many cases of tuberculosis are not identified or are diagnosed late, which increases the risk of poor evolution and death.
However, children with tuberculosis-associated pneumonia often have acute symptoms and are not considered probable cases of tuberculosis. In this context, the TB-Speed consortium hypothesized that screening young children admitted with a diagnosis of severe pneumonia for TB, followed by prompt treatment of those who screen positive, could reduce pneumonia mortality.
Tuberculosis-Accelerated Pneumonia is the first large-scale international cluster-randomized trial to evaluate the effect of molecular screening for tuberculosis in addition to standard World Health Organization (WHO) treatment in children admitted with severe pneumonia. Funded by Unitaid and the Initiative and supported by Inserm, the study was conducted in 16 tertiary care hospitals in six high-incidence TB countries (Côte d’Ivoire, Cameroon, Uganda, Mozambique, Zambia and Cambodia).
It assessed the mortality impact of systematic molecular detection of tuberculosis using the Xpert MTB/RIF Ultra (Ultra) rapid molecular diagnostic test performed on a nasopharyngeal aspirate specimen and a stool specimen, added to the WHO-recommended standard of care for severe pneumonia (including broad-spectrum antibiotic therapy, oxygen when indicated, and treatment of comorbidities such as HIV infection and severe malnutrition). Hospitals were randomly selected to gradually start molecular testing and sample flow was organized to reduce the time to result to 3 hours. All children with ultra-positive results were immediately enrolled in anti-tuberculosis treatment. Children were followed for 12 weeks after enrollment.
Between March 2019 and March 2021, a total of 2,570 children (1,401 in the control group and 1,169 in the intervention group) were enrolled in the study. 95% of children had nasopharyngeal aspiration, and 80% had feces collected and checked with the Ultra test. .
Although this screening did not reduce all-cause mortality at 12-week follow-up compared with standard care, it increased the number of children diagnosed with TB, particularly those with microbiological confirmation, and reduced the time to initiation of treatment.
In addition, the subgroup of children with severe acute malnutrition had 4-5 times higher rates of mortality and tuberculosis compared to other children. The study also showed that collection and testing of nasopharyngeal and stool samples with Xpert Ultra was feasible and well tolerated in highly susceptible children.