The transmission of tuberculosis in schools involving children 3 to 11 years of age

Little is known about the risk of tuberculosis transmission from children. We reviewed the published literature on the transmission of tuberculosis during outbreaks involving children 3 to 11 years of age and report that transmission rates among close contacts in school outbreaks are on average higher (weighted average 69.8% vs. 39.3%) if the index case is a child than an adult.     

Extensive transmission of Mycobacterium tuberculosis among children on a school bus

We report a tuberculosis outbreak in school children caused by exposure to a sputum-smear positive school bus driver. Exposed children were assessed using 2 versions of interferon-gamma release assays. Fifty-five percent (18/34) had a positive interferon-gamma release assays and 4 children developed tuberculosis. This suggests that transmission may be very efficient in this setting and highlights the need for early diagnosis.     

结核分枝杆菌基因分型方法研究进展

结核病是单一病原体所致死亡的主要原因.近年来,人口流动的增加和耐药结核分枝杆菌的增多更加剧了结核病在人群间的传播,因此必须加强对结核感染的控制和监测.分子流行病学,尤其是基因分型方法是监测结核病传播的有效途径.目前国内外广泛使用的基因分型方法有:插入序列6110限制性片段长度多态性、间隔区寡核苷酸分型法、多位点数目可变串联重复序列分析、单核苷酸多态性分析及缺失分析等.该文就这些分型方法作一综述.     

Cholesterol screening of seven-year-old children. How to identify children at risk

An inquiry was distributed to the parents of 1052 seven-year-old school beginners, concerning three issues, i.e. a known family history of myocardial infarction, angina pectoris before the age of 55 years and hyperlipidemia. A total of 147 children with a known family history were included in the study and compared with 148 classmates as control subjects. The proband children were subgrouped according to heredity factors and subjected to multivariate analysis at the 5% significance level for serum cholesterol fractions and triglycerides vs the control group. Statistically significant increased levels of total cholesterol and low density lipoprotein cholesterol, as well as an increased low density lipoprotein cholesterol and high density lipoprotein cholesterol ratio were found for all groups with hereditary for hyperlipidemia (p less than 0.001). However, no statistically significant difference was observed in the groups with heredity for myocardial infarction or angina pectoris exclusively. Also, there was no difference in any of the risk groups for high density lipoprotein cholesterol and triglycerides. The serum cholesterol levels in the present study were, to our knowledge, higher than those found elsewhere, except for Finland.     

Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children

The World Health Organization and UNICEF define non-oedematous severe acute malnutrition (SAM) either by a mid-upper arm circumference (MUAC) less than 115 mm or by a weight-for-height z-score (WHZ) less than -3. The objective of this study was to assess whether there was any benefit to identify malnourished children with a high risk of death to combine these two diagnostic criteria. Data of a longitudinal study examining the relationship between anthropometry and mortality in rural Senegal and predating the development of community-based management of SAM were used for this study. First, the receiver operating characteristic (ROC) curves of MUAC and of WHZ to predict mortality were drawn, and then the points corresponding to WHZ less than -3 and/or MUAC less than 115 mm were positioned in relation to these curves. MUAC had the highest ROC curve, which indicates that it identifies high-risk children better than WHZ. Both points representing WHZ less than -3 and/or MUAC less than 115 mm were below the MUAC ROC curve. It is concluded that to identify high-risk malnourished children, there is no benefit in using both WHZ less than -3 and/or MUAC less than 115 mm, and that using MUAC alone is preferable.     

Family history fails to identify many children with severe hypercholesterolemia

Optimal strategies for identifying children with hypercholesterolemia have not been established. Several groups have advocated that testing of serum cholesterol levels be limited to those children who have family histories of hyperlipidemia or premature coronary heart disease. We studied the ability of comprehensive family histories to identify children with hyperlipidemia in a group of 114 children (mean age, 8 +/- 4 years) who were referred for treatment of hypercholesterolemia. A positive family history was defined according to guidelines of the American Academy of Pediatrics. The mean fasting total cholesterol in the children was 5.74 +/- 1.42 mmol/L (222 mg/dL). Family history was negative for hypercholesterolemia or premature coronary heart disease in 22 (22%) of 100 children with total cholesterol levels greater than the 75th percentile for their ages, in 13 (18.3%) of 71 children with total cholesterol levels greater than the 95th percentile for their ages, and in four (11.8%) of 34 children with presumed heterozygous familial hypercholesterolemia. Of the 78 children who had both hypercholesterolemia and positive family histories, hyperlipidemia was reported in 72 families, whereas premature heart disease was reported in only 27. We conclude that in a population of children referred because of known hypercholesterolemia, a detailed family history not only fails to identify many children with mild hypercholesterolemia, but also fails to identify a significant proportion of children with markedly elevated cholesterol levels. Additionally, in families of children with hypercholesterolemia, a history of hyperlipidemia is more common than a history of premature heart disease.     

Transmission of mycobacterium tuberculosis to and from children and adolescents

Although adult-type pulmonary tuberculosis frequently arises from a long-dormant infection with Mycobacterium tuberculosis, children usually develop tuberculosis as a direct complication of the initial infection. Adults with pulmonary tuberculosis frequently are infectious, but children with typical primary tuberculosis—enlarged hilar or mediastinal lymph nodes with or without bronchial obstruction and subsequent atelectasis—rarely, if ever, transmit the organism to others. This article reviews the pathophysiology of pediatric tuberculosis and the published evidence concerning transmission of M tuberculosis to and from children and adolescents. Children with congenital tuberculosis or older children with the characteristics of adult-type tuberculosis should be considered potentially infectious. However, there is no evidence that children with primary-type tuberculosis infect other individuals. Recommendations are made concerning the handling of children with suspected tuberculosis and their family members in pediatric healthcare settings. Copyright © 2001 by W.B. Saunders Company     

SOS: a screening instrument to identify children with handwriting impairments

Poor handwriting has been shown to be associated with developmental disorders such as Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, autism, and learning disorders. Handwriting difficulties could lead to academic underachievement and poor self-esteem. Therapeutic intervention has been shown to be effective in treating children with poor handwriting, making early identification critical. The SOS test (Systematic Screening for Handwriting Difficulties) has been developed for this purpose. A child copies a sample of writing within 5 min. Handwriting quality is evaluated using six criteria and writing speed is measured. The Dutch SOS test was administered to 860 Flemish children (7-12 years). Inter- and intrarater reliability was excellent. Test-retest reliability was moderate. A correlation coefficient of 0.70 between SOS and "Concise Assessment Methods of Children Handwriting" test (Dutch version) confirmed convergent validity. The SOS allowed discrimination between typically developing children and children in special education, males and females, and different age groups.     

Screening programs to identify children at risk for diabetes mellitus: psychological impact on children and parents

Screening programs to identify persons atrisk for diabetes mellitus (DM), before disease onset, are considered essential to understanding the natural history of the disease and for prevention program development. However, screening programs are complicated by imprecise markers of disease risk, the absence of a known effective prevention method, the use of children, and a wide variety of psychological, social, and educational challenges. Research relevant to four issues is presented: (1) parent and child anxiety in response to at-risk notification as well as how participants cope with this news; (2) accuracy of mothers' understanding of their babies' risk status; (3) predictors of participant recruitment and retention in longitudinal studies of this type; and (4) protocol compliance in prevention trials for type 1 DM. Integration of behavioral research into screening and prevention trials would help address the ethical concerns raised by such trials and improve their scientific quality.     

Response to changes in antiretroviral therapy after genotyping in human immunodeficiency virus-infected children

BACKGROUND: HIV genotyping has been beneficial when choosing salvage regimens in adults failing highly active antiretroviral therapy (HAART). Our objectives were to evaluate the usefulness of genotyping in HIVinfected children failing HAART and to determine whether the presence of resistance mutations was associated with previous antiretroviral therapy. METHODS: We followed the progress of pediatric patients who had HIV genotyping performed after HAART failure. Charts were reviewed at 3-month intervals for 1 year after genotyping for changes in viral load and CD4+ cell percentage. Patients whose antiretroviral therapy was changed after genotyping were compared with those whose medications were not changed. We also compared the proportion of patients with genotypic mutations according to antiretroviral exposure at time of genotyping. RESULTS: Eighteen pediatric patients were eligible for inclusion. None of 10 patients who had antiretroviral therapy changed after genotyping had a decrease in viral load atmonths after genotyping. One of 8 patients who had no changes in antiretroviral therapy had a sustained decrease in viral load at 12 months. Two-thirds of patients had resistance mutations to antiretrovirals without prior exposure to that drug. CONCLUSIONS: This study did not demonstrate substantial clinical benefit to HIV genotyping in antiretroviral agent-experienced pediatric patients with high viral loads. These results contrast with favorable short term clinical and virologic responses to therapeutic changes after genotyping in HIV-infected adults. However, medication history alone does not appear to be an adequate alternative to genotyping in choosing salvage regimens in antiretroviral agent-experienced children.