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Understanding the interaction between cytomegalovirus and tuberculosis in children: The way forward
Laura Olbrich1,2,3, Lisa Stockdale3,4,5, Robindra Basu Roy6
1Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
Insights
Coinfection with cytomegalovirus (CMV) may worsen tuberculosis (TB) outcomes in children. Understanding this interaction is crucial for improving pediatric TB diagnosis and treatment strategies.
Area of Science:
- Pediatric infectious diseases
- Immunology
- Epidemiology
Background:
- Tuberculosis (TB) affects over 1 million children annually, with significant mortality.
- Cytomegalovirus (CMV) coinfection is increasingly recognized as a factor influencing TB progression and outcomes in children.
- The interplay between TB and CMV in pediatric populations, including immunological interactions and clinical consequences, remains incompletely understood.
Purpose of the Study:
- To review the existing literature on CMV and TB coinfection in children.
- To explore the immunological interactions between CMV and Mycobacterium tuberculosis (Mtb).
- To identify research gaps and suggest future study directions for pediatric TB and CMV coinfection.
Main Methods:
- Comprehensive review of epidemiological, clinical, and immunological studies on CMV and TB in children.
- Exploration of the impact of HIV coinfection on the TB-CMV relationship.
- Analysis of current research limitations, including inconsistent definitions and methodologies.
Main Results:
- CMV coinfection may influence Mtb disease progression, TB disease type, diagnostic test performance, and overall outcomes in children.
- Mtb infection may also impact CMV pathogenesis.
- The relationship is further complicated by the presence of HIV coinfection.
Conclusions:
- Further research is needed to clarify the burden, immunological interactions, and clinical impact of CMV-TB coinfection in children.
- Standardized definitions, study designs, and laboratory practices are essential for advancing research in this area.
- Addressing coinfections like CMV is critical for achieving global TB elimination targets in children.
Abstract:
Over 1 million children develop tuberculosis (TB) each year, with a quarter dying. Multiple factors impact the risk of a child being exposed to Mycobacterium tuberculosis (Mtb), the risk of progressing to TB disease, and the risk of dying. However, an emerging body of evidence suggests that coinfection with cytomegalovirus (CMV), a ubiquitous herpes virus, impacts the host response to Mtb, potentially influencing the probability of disease progression, type of TB disease, performance of TB diagnostics, and disease outcome. It is also likely that infection with Mtb impacts CMV pathogenesis. Our current understanding of the burden of these 2 diseases in children, their immunological interactions, and the clinical consequence of coinfection is incomplete. It is also unclear how potential interventions might affect disease progression and outcome for TB or CMV. This article reviews the epidemiological, clinical, and immunological literature on CMV and TB in children and explores how the 2 pathogens interact, while also considering the impact of HIV on this relationship. It outlines areas of research uncertainty and makes practical suggestions as to potential studies that might address these gaps. Current research is hampered by inconsistent definitions, study designs, and laboratory practices, and more consistency and collaboration between researchers would lead to greater clarity. The ambitious targets outlined in the World Health Organization End TB Strategy will only be met through a better understanding of all aspects of child TB, including the substantial impact of coinfections.
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