Castleman’s disease in the HIV-endemic setting

Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.

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Safety and immunogenicity of candidate vaccine M72/AS01E in adolescents in a TB endemic setting

Vaccine ◽

10.1016/j.vaccine.2015.05.088 ◽

2015 ◽

Vol 33 (32) ◽

pp. 4025-4034 ◽

Cited By ~ 66

Author(s):

Adam Penn-Nicholson ◽

Hennie Geldenhuys ◽

Wivine Burny ◽

Robbert van der Most ◽

Cheryl L. Day ◽

...

Keyword(s):

Candidate Vaccine ◽

Endemic Setting

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Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegypti in Yogyakarta, Indonesia: a quasi-experimental trial using controlled interrupted time series analysis

10.1101/2020.03.15.20036566 ◽

2020 ◽

Cited By ~ 1

Author(s):

Citra Indriani ◽

Warsito Tantowijoyo ◽

Edwige Rancès ◽

Bekti Andari ◽

Equatori Prabowo ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Control Area ◽

Northern Australia ◽

Interrupted Time Series Analysis ◽

Endemic Setting ◽

Experimental Trial ◽

Series Analysis ◽

Quasi Experimental

AbstractBackgroundAe. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis (wMel strain) have been deployed for the biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia-treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia.Methods and findingsIn Yogyakarta City, Indonesia, following an extensive community engagement campaign, wMel Wolbachia-carrying mosquitoes were released every two weeks for 13–15 release rounds over seven months in 2016–17, in a contiguous 5 km2 area (population 65,000). A 3 km2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area, on the basis of comparable socio-demographic characteristics and historical dengue incidence. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time series analysis. Rapid and sustained introgression of wMel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during the 24 months after Wolbachia was deployed. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including an additional 6 months of post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years; 76% reduction in incidence, 95%CI 60%,86%).ConclusionsThese findings demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These results are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for the control of dengue and other Aedes-borne diseases.

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Imported Malaria at a Referral Hospital in Tokyo from 2005 to 2016: Clinical Experience and Challenges in a Non-Endemic Setting

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.18-0722 ◽

2019 ◽

Vol 100 (4) ◽

pp. 828-834 ◽

Cited By ~ 2

Author(s):

Saho Takaya ◽

Yasuyuki Kato ◽

Yuichi Katanami ◽

Kei Yamamoto ◽

Satoshi Kutsuna ◽

...

Keyword(s):

Clinical Experience ◽

Imported Malaria ◽

Referral Hospital ◽

Endemic Setting

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Comprehensive Strategy to Prevent Nosocomial Spread of Methicillin-Resistant Staphylococcus aureus in a Highly Endemic Setting

Archives of Internal Medicine ◽

10.1001/archinte.164.18.2038 ◽

2004 ◽

Vol 164 (18) ◽

pp. 2038 ◽

Cited By ~ 59

Author(s):

Viktorija Tomic ◽

Petra Svetina Sorli ◽

Darinka Trinkaus ◽

Jurij Sorli ◽

Andreas F. Widmer ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Comprehensive Strategy ◽

Methicillin Resistant ◽

Endemic Setting

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