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Tuberculosis: In nations with excessive incidence, youngsters hospitalized with extreme pneumonia needs to be screened for tuberculosis | press room

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In countries with a high incidence of tuberculosis, the disease can be a cause of severe pneumonia in children and contribute to mortality in the youngest. © TB speed

Tuberculosis affects 1 million children each year, less than half of whom are diagnosed and treated, resulting in more than 200,000 deaths each year. In a new study, researchers and clinicians from the University of Bordeaux, the Institute of Research for Development (IRD) of Inserm and the MU-JHU (research collaboration between Makerere University and the University of Johns Hopkins in Uganda) have joined forces within the TB speed ​​grouped consortium, showed that intake screening for tuberculosis in children with severe pneumonia is feasible.

In addition, such screening with a test called Xpert Ultra would improve the diagnosis of tuberculosis in children in countries with high incidence of the disease. The results of the study support a more systematic use of Xpert Ultra in these children, particularly those suffering from severe acute malnutrition. Finally, they confirm the importance of tuberculosis as a cause of severe pneumonia in children. The results have been published in since November 15, 2022 The Lancet Infectious Diseases.

In countries with a high incidence of tuberculosis, the disease can be a cause of severe pneumonia in children and contribute to mortality in the youngest. Usually, a diagnosis of tuberculosis is considered only in children with persistent symptoms, in children who have failed one or more antibiotic treatments for community-acquired pneumonia, or in children with a history of contact with a sick person. As a result, many cases of tuberculosis go undetected or are diagnosed late, increasing the risk of poor development and death.

However, children with tuberculosis-related pneumonia very often have acute symptoms and are not suspected cases of tuberculosis. In this regard, the TB Speed ​​consortium hypothesized that screening infants admitted for TB with severe pneumonia, followed by prompt treatment of those who tested positive, might reduce the mortality from severe pneumonia from severe TB .

TB-Speed ​​​​​​Pneumonia is the first large-scale international cluster-randomized study to evaluate the effect of molecular screening for tuberculosis on top of standard World Health Organization (WHO) care in children admitted for severe pneumonia. Funded by Unitaid and the Initiative and sponsored by Inserm, the study was conducted in 16 tertiary hospitals in six countries with high tuberculosis incidence (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 sample and a stool sample, supplemented with the WHO recommended standard of care for severe pneumonia ( including treatment with broad-spectrum antibiotics, oxygen if indicated, and treatment of comorbidities such as HIV infection and severe malnutrition). Hospitals were randomized to begin molecular testing in a phased manner, and sample flow was organized to reduce the time to receive results to 3 hours. All children with ultra-positive results were immediately placed on tuberculosis treatment. The children were followed for 12 weeks after enrollment.

Between March 2019 and March 2021, a total of 2570 children (1401 in the control arm and 1169 in the intervention arm) were included in the study. Nasopharyngeal aspiration was collected from 95% of the children and stool was collected from 80% and tested with the Ultra-Test.

Although this screening did not reduce all-cause mortality at 12 weeks of follow-up compared to standard of care, it increased the number of children diagnosed with tuberculosis, particularly those with microbiological confirmation, and reduced the time to initiation of treatment.

In addition, case mortality and TB detection rates were four to five times higher in the subgroup of children with severe acute malnutrition compared to other children. The study also showed that collecting and testing nasopharyngeal and stool samples with Xpert Ultra was feasible and well tolerated in very susceptible children.

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