1 - General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
2 - La Paz Research Institute (IdiPAZ), Madrid, Spain.
3 - Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
4 - Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
5 - Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria.
6 - Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
7 - Department of Infection, Immunity & Inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
8 - Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
9 - Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
10 - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
11 - Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Seville, Spain.
12 - Paediatric Infectious Diseases Department, Royal Alexandra Children's Hospital, Brighton, United Kingdom.
13 - Department of Pediatric Pneumology, Allergology and CF Center, University Children's Hospital Bochum, Bochum, Germany.
14 - Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
15 - Department of Paediatrics & Paediatric Infectious Diseases, Children's Hospital of Central Switzerland, Lucerne, Switzerland.
16 - Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research University of Basel, Basel, Switzerland.
17 - Infectious diseases Unit, Pediatrics Department, Hospital Dona Estefânia, Centro Hospitalar e Universitário Lisboa Central, Lisboa, Portugal.
18 - Centre for Treatment Children with HIV/AIDS, National Specialised Children's Hospital "OKHMATDYT", Kyiv, Ukraine.
19 - Pediatric TB Department, National institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine, Kyiv, Ukraine.
20 - Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, Rome, Italy.
21 - Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain.
22 - UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain.
23 - Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
24 - St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russia.
25 - Pediatric Infectious Disease Unit, University Hospital Policlinico "Federico II", Naples, Italy.
26 - Department of Translational Medical Sciences-Section of Pediatrics, University of Naples "Federico II", Naples, Italy.
27 - Pediatrics Infectious Diseases Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
28 - Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
29 - Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain.
30 - Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
31 - Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, United Kingdom.
32 - Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria, Spain.
33 - Department of Pediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain.
34 - Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, Stockholm, Sweden.
35 - Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario Regional de Málaga, Málaga, Spain.
36 - Pediatrics Department, Marqués de Valdecilla University Hospital, Santander, Spain.
37 - Pediatric Infectious Diseases Unit, Hospital General de Castellón, Castellón, Spain.
38 - Pediatrics Department, Hospital Universitario La Fe, Valencia, Spain.
39 - Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria.
40 - Department of Infectology, Centre of Tuberculosis and Lung Diseases of Riga Eastern Clinical University Hospital, Riga, Latvia.
41 - Pediatrics Department, Albacete University Hospital, Albacete, Spain.
42 - Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital de Basurto, Basurto, Spain.
43 - Pediatrics Department, Getafe University Hospital, Getafe, Spain.
44 - Pediatrics Department, Príncipe de Asturias University Hospital, Alcalá de Henares, Spain.
45 - Medicine Department, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain.
46 - Pediatrics Department, Donostia University Hospital, San Sebastián, Spain.
47 - Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
48 - Pediatrics Department, Navarra University Hospital, Navarra, Spain.
49 - Research Unit, Hospital Universitario La Paz, Madrid, Spain.
50 - Institute for Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
51 - Paediatric Infectious Diseases and Immunodeficiencies Unit, St. George's University Hospital, NHS Foundation Trust, London, United Kingdom.
- Clin Infect Dis. 2024 Jul 19;79(1):215-222. doi: 10.1093/cid/ciae158.
Resumo:
Background: In high-resource settings, the survival of children with immunocompromise (IC) has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools, and outcome of IC children with tuberculosis (TB) in Europe.
Methods: Multicenter, matched case-control study within the Pediatric Tuberculosis Network European Trials Group, capturing TB cases <18 years diagnosed 2000-2020.
Results: A total of 417 TB cases were included, comprising 139 children who are IC (human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression, and other immunocompromising conditions) and 278 non-IC children as controls. Nonrespiratory TB was more frequent among cases than controls (32.4% vs 21.2%; P = .013). Patients with IC had an increased likelihood of presenting with severe disease (57.6% vs 38.5%; P < .001; odds ratio [95% confidence interval], 2.073 [1.37-3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs 6.0%; P < .001) and QuantiFERON-TB Gold assay (30.0% vs 7.3%; P < .001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs 49.3%; P = .083). Although the mortality in children with IC was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs 6.1%; P = .004).
Conclusions: Children with IC and TB in Europe have increased rates of nonrespiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in patients with IC, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies.
Palavras Chave: Europe; immune-based tests; immunodeficiency; immunosuppression; tuberculosis.