A Brief Overview of Mycobacterial Diseases in Children
Table 4: Future Challenges in the Management of Mycobacterial Infection and Disease in Children Mycobacterium tuberculosis
Non-tuberculous Mycobacteria Epidemiology New tools and guidelines for accurate
of NTM in children is not known. NTM diseases are not notifiable diseases in
Mycobacterium leprae Better notification and reporting of severe New tools and guidelines for more accurate
detection and reporting of childhood TB: NTM disease in children: the global burden detection and reporting of leprosy in efforts must be made to improve the accuracy of reporting of childhood TB cases, also in industrialised countries. The global burden of childhood TB is probably underreported, due to
paucibacillary disease, low contribution to TB epidemiology and neglect by some national TB programmes. Data suggest a rise in proportion of TB caseload by children, up to 40 % in some high incidence settings Identification of exposed children at risk of severe disease: the risk of disease is highest in the first 12 months following infection, especially in young and in
HIV-infected children, with the highest risk
of severe disease. Timely identification and adequate management of these children is necessary to prevent progression to disease
Transmission and Pathogenesis
Knowledge of the different transmission Clarification of modes of transmission of Clarifying of the pathogenesis and mode of
epidemiology in non-endemic and endemic NTM: studies suggest that NTMs may be transmission of leprosy: research methods, regions: transmission within non-endemic transmitted via inhalation or direct areas (for example western Europe and the US) is limited, mainly to immigrant
inoculation or wound contamination. Studies, using molecular epidemiology
populations and the socially disadvantaged. methods are needed to clarify the exact Most cases of TB disease result from reactivation of LTBI. High transmission
mechanisms of transmission of NTMs
level in TB-endemic areas is sustained by to define the role of specific genetic a high prevalence of undiagnosed and/or susceptibility of some individuals to untreated TB. This is relevant for local public health policy
NTM disease
Addressing environmental and social factors that maintain transmission: this includes social interactions, tobacco smoke, biofuel exposure, poverty and crowding, etc
Research on more reliable measures of MTB transmission in the community: the presently used ARI as a measure of transmission in the community has a few important disadvantages. It measures the prevalence of TST positivity in schoolchildren, a group known to have a limited risk of TB infection/disease, thereby limiting its generalisation to the high-risk groups within the community Genetic susceptibility: research is needed to define the role of specific genetic susceptibility of some groups of children to MTB disease
Burden of Disease Burden of TB in children: diagnostic difficulties and poor reporting systems, especially in endemic regions make it impossible to accurately quantify the global burden of childhood TB
Burden of NTM disease in children: the Burden of leprosy in children: the wide range
growing population of children susceptible of notification figures of childhood leprosy to NTM disease, including those with HIV, from different global regions suggests that malignancy and chronic lung disease calls the exact burden of disease is unknown. for a better registration system for NTM
Addressing the influence of HIV infection disease in children. This will contribute
on TB epidemic: the age and gender shift to a more accurate estimation of the real of HIV in young adults of child-bearing age, burden of childhood NTM disease increases future risk of TB in young children in high HIV-prevalent settings
EUROPEAN INFECTIOUS DISEASE 107
Efforts must be made to achieve better notification in children
using molecular epidemiology tools are needed to clarify mechanisms of the pathogenesis and transmissibilty of
M. leprae, to detect de novo infection and reactivation within contacts and identify the
Genetic susceptibility: research is needed relationship between clinical outcome and strain type
Genetic susceptibility: research is needed to define the role of genetic susceptibility to leprosy. Although a genome-wide association study has identified
candidate genes, their specific role in the epidemiology of leprosy is still unknown
children: although global leprosy prevalence values fell significantly between 2002 and
most countries, the incidence is difficult 2009, high numbers of new cases, including to determine
children, continue to be detected in leprosy endemic regions. Tools for accurate, comparable detection of new paediatric cases must be implemented
Active screening and monitoring of children in contact with an infective index case of leprosy: identification and adequate
management of persons in contact with an infectious (multibacillary) index case will prevent development of (severe) disease and disability, in addition to further transmissibility in the community
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