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Analysis of 18FDG PET/CT Imaging as a Tool for Studying Mycobacterium tuberculosis Infection and Treatment in Non-human Primates
Published on: September 5, 2017
Tuberculosis -- persistent threat to human health
1Jaslok Hospital and Medical Research Center, Mumbai, Maharashtra, India. ykakr@vsnl.com
Insights
Childhood tuberculosis is a significant global health issue, comprising 40% of cases. Effective control requires early detection and treatment compliance, as childhood infections can fuel adult disease transmission.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Childhood tuberculosis (TB) constitutes 40% of global cases, highlighting its critical importance in disease control.
- Increasing evidence suggests childhood infections are a primary source for adult TB reactivation and transmission, necessitating greater focus on pediatric TB.
- Traditional understanding of TB transmission, focusing on adult sources for childhood cases, is being revised to acknowledge the reciprocal relationship.
Purpose of the Study:
- To emphasize the critical need for enhanced attention to childhood tuberculosis for effective global TB control.
- To highlight the diagnostic challenges in pediatric TB due to low bacillary load and inaccessible sites.
- To underscore the importance of treatment compliance and the limitations of current control strategies.
Main Methods:
- Review of current understanding of TB transmission dynamics, particularly concerning childhood infections.
- Analysis of diagnostic difficulties, including limitations of conventional tests like tuberculin tests and radiology.
- Examination of factors contributing to TB control program failures, such as poor treatment compliance.
Main Results:
- Childhood TB is a major contributor to the global TB burden and disease transmission cycles.
- Diagnosis of childhood TB is challenging due to paucibacillary nature and lack of typical clinical presentations.
- Low treatment compliance and limited use of recommended strategies like Directly Observed Treatment, Short-course (DOTS) hinder TB control.
Conclusions:
- Childhood tuberculosis requires equal or greater attention than adult TB for effective global control.
- Improved diagnostic methods and strategies to ensure treatment compliance are essential for managing pediatric TB.
- Addressing misconceptions and increasing accountability are crucial for successful TB management and control programs.
Abstract:
With the increasing incidence of tuberculosis worldwide, childhood cases now constitute 40% of the total. TB control thus has global importance. Unfortunately, control of disease is not in sight. It was always thought that adult tuberculosis is the fountainhead of childhood tuberculosis but it is being increasingly realized that it is the infection acquired during childhood that promotes reactivation of adult disease, which in turn maintains the chain of transmission. Thus childhood tuberculosis needs equal or more attention for effective control. Early detection by simple tests and ensuring treatment compliance is the goal. The small number of bacilli and inaccessible sites for bacteriological confirmation makes diagnosis of childhood tuberculosis difficult. Circumstantial evidence is often the basis of diagnosis. However, as clinical manifestations depend upon host immune response and virulence of tubercle bacilli, there is no typical clinical presentation. A large number of infected children may remain asymptomatic, undiagnosed and untreated. Conventional tests such as tuberculin test and radiology are not fully dependable and newer tests have limitations. Poor patient treatment compliance contributes to failure of a tuberculosis control program and leads to drug resistance. To combat this, direct observed treatment (DOTS) has been unanimously recommended in treatment of tuberculosis. DOTS is however estimated to be used in less than 40% of new cases. Misconceptions threaten to undermine continued success in tuberculosis control. TB control is essentially a management problem. Greater accountability of governments, donors and providers is essential.
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