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This work contains updated and clinically relevant information about tuberculosis. It is aimed at providing a succinct overview of history and disease epidemiology, clinical presentation and the most recent scientific developments in the field of tuberculosis research, with an emphasis on diagnosis and treatment. It may serve as a practical resource for students, clinicians and researchers who work in the field of infectious diseases.
This work contains updated and clinically relevant information about tuberculosis. It is aimed at providing a succinct overview of history and disease epidemiology, clinical presentation and the most recent scientific developments in the field of tuberculosis research, with an emphasis on diagnosis and treatment. It may serve as a practical resource for students, clinicians and researchers who work in the field of infectious diseases.
It is estimated that one third of the world's population is infected with Mycobacterium tuberculosis (the bacterium that causes tuberculosis (TB)), and that each year, about 9 million people develop TB, of whom about 2 million die. Of the 9 million annual TB cases, about 1 million (11%) occur in children (under 15 years of age). Of these childhood cases, 75% occur annually in 22 high-burden countries that together account for 80% of the world's estimated incident cases. In countries worldwide, the reported percentage of all TB cases occurring in children varies from 3% to more than 25%. The Stop TB Strategy, which builds on the DOTS strategy developed by the World Health Organization (WHO) and the International Union Against TB and Lung Disease, has a critical role in reducing the worldwide burden of disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. These consensus guidelines were produced to help the National Tuberculosis Programmes on the management of tuberculosis in children.
Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
Tuberculosis remains one of the most prevalent, deadly, and underdiagnosed infectious diseases in the world. In children, this burden is doubly problematic because of the disease's unique clinical characteristics and its need for special public health and diagnostic techniques. After decades of relative inattention to these factors, childhood tuberculosis has now grown into an important area of competency for child health programs in low-burden areas, including the United States. The Handbook of Child and Adolescent Tuberculosis is a state of the art clinical reference written and edited by the world's leading experts in childhood tuberculosis. It offers clinicians in any geography or setting practical, evidence-based advice on all aspects of the disease, including its natural history, epidemiology, presentation, treatment, and prevention -- all in a format that synthesizes literature with the clinical experience of the leading authorities in this challenging field. As the need for childhood tuberculosis services in child health programs grows, this handbook provides a new benchmark for practitioners and trainees in pediatrics, infectious disease, pulmonary medicine, and public health to better understand this persisting and difficult disease.
BACKGROUND: Latent tuberculosis infection (LTBI), defined as a state of persistent immune response to prior-acquired Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB, affects about one-third of the world's population. Approximately 10% of people with LTBI will develop active TB disease in their lifetime, with the majority developing it within the first five years after initial infection. Currently available treatments have an efficacy ranging from 60% to 90%. Systematic testing and treatment of LTBI in at-risk populations is a critical component of WHO's eight-point framework adapted from the End TB Strategy to target pre-elimination and, ultimately, elimination in low incidence countries. OVERVIEW: Recognizing the importance of expanding the response to LTBI, in 2014 WHO developed Guidelines on the Management of Latent Tuberculosis Infection. The guidelines are primarily targeted at high-income or upper middle-income countries with an estimated TB incidence rate of less than 100 per 100 000 population, because they are most likely to benefit from it due to their current TB epidemiology and resource availability. The overall objective of the guidelines is to provide public health approach guidance on evidence-based practices for testing, treating and managing LTBI in individuals with the highest risk of progression to active disease. Specific objectives include identifying and prioritizing at-risk population groups for targeted intervention of LTBI testing and treatment, including defining an algorithm, and recommending specific treatment options. The guidelines are expected to provide the basis and rationale for the development of national guidelines for LTBI management based on available resources, epidemiology of TB including intensity of transmission, the health-care delivery system of the country, and other national and local determinants.
Current data and trends in morbidity and mortality for the sub-Saharan Region as presented in this new edition reflect the heavy toll that HIV/AIDS has had on health indicators, leading to either a stalling or reversal of the gains made, not just for communicable disorders, but for cancers, as well as mental and neurological disorders.
The WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease is an updated and consolidated summary of WHO recommendations on systematic screening for tuberculosis (TB) disease, containing 17 recommendations for populations in which TB screening should be conducted and tools to be used for TB screening. TB screening is strongly recommendations for household and close contacts of individuals with TB, people living with HIV, miners exposed to silica dust, and prisoners. In addition, screening is conditionally recommended for people with risk factors for TB attending health care, and for communities with risk factors for TB and limited access to care (e.g. homeless, urban poor, refugees, migrants). General population screening is recommended in high-burden settings (0.5% prevalence or higher). Symptoms, chest radiography (CXR), and molecular WHO-recommended rapid diagnostic tests for TB are recommended as screening tools for all adults eligible for screening. Computer-aided detection programmes are recommended as alternatives to human interpretation of CXR in settings where trained personnel are scarce. For people living with HIV, C-reactive protein is also a good screening tool. This guideline document is accompanied by an operational handbook, the WHO operational handbook on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease, that presents principles of screening, steps in planning and implementing a screening programme, and algorithm options for screening different populations.
In Zambia, due to the rise of tuberculosis and the closely connected HIV epidemic, a large number of children have experienced the illness or death of at least one parent. Children as Caregivers examines how well intentioned practitioners fail to realize that children take on active caregiving roles when their guardians become seriously ill and demonstrates why understanding children’s care is crucial for global health policy. Using ethnographic methods, and listening to the voices of the young as well as adults, Jean Hunleth makes the caregiving work of children visible. She shows how children actively seek to “get closer” to ill guardians by providing good care. Both children and ill adults define good care as attentiveness of the young to adults’ physical needs, the ability to carry out treatment and medication programs in the home, and above all, the need to maintain physical closeness and proximity. Children understand that losing their guardians will not only be emotionally devastating, but that such loss is likely to set them adrift in Zambian society, where education and advancement depend on maintaining familial, reciprocal relationships. View a gallery of images from the book (https://www.flickr.com/photos/childrenascaregivers)
The main purpose of these recommendations is to assist national and local public health tuberculosis (TB) control programmes in low- and middle-income countries to develop and implement case finding among people exposed to infectious cases of TB. Systematic evaluation of people who have been exposed to potentially infectious cases of tuberculosis (TB) can be an efficient, targeted approach to intensified TB case finding that is within the purview of TB control programmes. There are, however, no comprehensive global recommendations for programmes. WHO, the International Union against Tuberculosis and Lung Disease and the International Standards for Tuberculosis Care all recommend that children under 5 years of age and persons living with HIV (PLHIV) who are exposed to infectious cases of TB be evaluated for active TB and considered for treatment of latent tuberculosis infection (LTBI) if active TB is excluded. With these exceptions, there are no recommendations at global level to: 1. define the epidemiological and programme conditions under which contact investigation is indicated;2. describe TB index patients on whom contact investigation should be focused;3. identify TB contacts who should be investigated (other than children under 5 years of age and PLHIV);and recommend the procedures to be used for identifying, screening and tracking TB contacts. The following recommendations are based on recent systematic reviews of the literature on contact investigation in low- and middle-income countries.