Background Currently, data on treatment, outcome, and prognostic factors in children with tubercu... more Background Currently, data on treatment, outcome, and prognostic factors in children with tuberculous meningitis (TBM) in Europe are limited. To date, most existing data on TBM originate from adult studies, or studies conducted in low-resource settings. Methods We designed a multicenter, retrospective study involving 27 pediatric healthcare institutions in 9 European countries via an established pediatric TB research network, before and after the 2014 revision of World Health Organization (WHO) dosing recommendations. Results Of 118 children, 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2, and 11 (9.3%) grade 3. Fifty-eight (49.1%) children received a standard 4-drug treatment regimen; other commonly used drugs included streptomycin, prothionamide, and amikacin. Almost half of the patients (48.3%; 56/116) were admitted to intensive care unit, with a median stay of 10 (interquartile range [IQR] 4.5–21.0) days. Of 104 children with complete outcome data, 9.6% (10/104) died, and only 4...
American journal of respiratory and critical care medicine, Jan 12, 2015
Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release as... more Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low incidence countries of tuberculosis. We analyzed IGRA results and the effect of preventive chemotherapy on tuberculosis progression rates among recent contacts. Results from contact investigations at 26 centers in 10 European countries including testing for latent infection with Mycobacterium tuberculosis by the QuantiFERON-Gold in-Tube (QFT) test or the T-SPOT.TB (TSPOT) were prospectively collected and analyzed. Among 5020 contacts of 1023 index cases, 25 prevalent secondary cases were identified at screening. Twenty-four incident cases occurred among 4513 contacts during 12326 years of cumulative follow-up. In those with a positive IGRA result, tuberculosis incidence was 0.2 (QFT) and 0 (TSPO...
Die Tuberkulose (TB) zählt zu den häufigsten Infektionskrankheiten, mit weltweit 250.000 Todesfäl... more Die Tuberkulose (TB) zählt zu den häufigsten Infektionskrankheiten, mit weltweit 250.000 Todesfällen allein unter Kindern im Jahr 2016. Mehrere Institutionen sowie Fachgruppen (World Health Organization – WHO, European Centre for Disease Prevention and Control – ECDC, European Research Council ERS, etc.) haben Richtlinien zur Diagnostik und Therapie der TB erstellt. Kürzlich wurde für 3 Staaten – Österreich, Schweiz und Deutschland – eine eigene Leitlinie zur Diagnostik und Therapie der pädiatrischen TB erstellt. Diese Arbeit soll die wichtigsten Punkte für den klinischen Alltag hervorheben, Beispiele aus der klinischen Erfahrung unseres pädiatrischen Zentrums präsentieren und bestimmte Aspekte der publizierten Leitlinie kommentieren. Neben Anamnese und klinischen Symptomen wird vor allem auf die diagnostischen Schritte im Detail eingegangen, die neben radiologischen Untersuchungen, vor allem immunologische Tests, wie den Mendel-Mantoux-Test (MMT), sowie den Interferon-γ Release Assay (IGRA), umfassen. Auch auf die Schwierigkeit der Diagnosestellung im Kindes- und Jugendalter bei unklarer Symptomatik bzw. bei Fehlen eines Indexpatienten wird eingegangen. Neben der Chemoprophylaxe nach Exposition und der Chemoprävention als Behandlung bei latenter TB, werden auch die therapeutischen Optionen bei manifester TB – pulmonal sowie extrapulmonal – diskutiert. Auch die Behandlung der multiresistenten TB, einem zunehmenden klinisch-therapeutischen sowie wirtschaftlichen Problem, wird ebenso thematisiert. Die Zusammenfassung dieser Leitlinie soll eine wertvolle Ergänzung im klinischen Alltag für die Diagnostik und Therapie der TB im Kindes- und Jugendalter im deutschsprachigen Raum darstellen.
ZusammenfassungAktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tub... more ZusammenfassungAktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenüber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Prävention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar.Leitlinien für die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter können nicht generell auf das Kindesalter übertragen werden, da hier relevante altersabhängige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Maßnahmen und der Therapie bestehen.Unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie für die Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adäquate Versorgung von Kindern und Jugendlichen mit...
Summary Background To date, few data on paediatric COVID-19 have been published, and most reports... more Summary Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and in...
Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are ... more Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Methods Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. Results A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used...
Europe has the highest documented caseload and greatest increase in multidrug and extensively dru... more Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with >10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by > 2 months. Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop.
American journal of respiratory and critical care medicine, Jan 12, 2015
Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release as... more Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low incidence countries of tuberculosis. We analyzed IGRA results and the effect of preventive chemotherapy on tuberculosis progression rates among recent contacts. Results from contact investigations at 26 centers in 10 European countries including testing for latent infection with Mycobacterium tuberculosis by the QuantiFERON-Gold in-Tube (QFT) test or the T-SPOT.TB (TSPOT) were prospectively collected and analyzed. Among 5020 contacts of 1023 index cases, 25 prevalent secondary cases were identified at screening. Twenty-four incident cases occurred among 4513 contacts during 12326 years of cumulative follow-up. In those with a positive IGRA result, tuberculosis incidence was 0.2 (QFT) and 0 (TSPO...
Background Currently, data on treatment, outcome, and prognostic factors in children with tubercu... more Background Currently, data on treatment, outcome, and prognostic factors in children with tuberculous meningitis (TBM) in Europe are limited. To date, most existing data on TBM originate from adult studies, or studies conducted in low-resource settings. Methods We designed a multicenter, retrospective study involving 27 pediatric healthcare institutions in 9 European countries via an established pediatric TB research network, before and after the 2014 revision of World Health Organization (WHO) dosing recommendations. Results Of 118 children, 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2, and 11 (9.3%) grade 3. Fifty-eight (49.1%) children received a standard 4-drug treatment regimen; other commonly used drugs included streptomycin, prothionamide, and amikacin. Almost half of the patients (48.3%; 56/116) were admitted to intensive care unit, with a median stay of 10 (interquartile range [IQR] 4.5–21.0) days. Of 104 children with complete outcome data, 9.6% (10/104) died, and only 4...
American journal of respiratory and critical care medicine, Jan 12, 2015
Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release as... more Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low incidence countries of tuberculosis. We analyzed IGRA results and the effect of preventive chemotherapy on tuberculosis progression rates among recent contacts. Results from contact investigations at 26 centers in 10 European countries including testing for latent infection with Mycobacterium tuberculosis by the QuantiFERON-Gold in-Tube (QFT) test or the T-SPOT.TB (TSPOT) were prospectively collected and analyzed. Among 5020 contacts of 1023 index cases, 25 prevalent secondary cases were identified at screening. Twenty-four incident cases occurred among 4513 contacts during 12326 years of cumulative follow-up. In those with a positive IGRA result, tuberculosis incidence was 0.2 (QFT) and 0 (TSPO...
Die Tuberkulose (TB) zählt zu den häufigsten Infektionskrankheiten, mit weltweit 250.000 Todesfäl... more Die Tuberkulose (TB) zählt zu den häufigsten Infektionskrankheiten, mit weltweit 250.000 Todesfällen allein unter Kindern im Jahr 2016. Mehrere Institutionen sowie Fachgruppen (World Health Organization – WHO, European Centre for Disease Prevention and Control – ECDC, European Research Council ERS, etc.) haben Richtlinien zur Diagnostik und Therapie der TB erstellt. Kürzlich wurde für 3 Staaten – Österreich, Schweiz und Deutschland – eine eigene Leitlinie zur Diagnostik und Therapie der pädiatrischen TB erstellt. Diese Arbeit soll die wichtigsten Punkte für den klinischen Alltag hervorheben, Beispiele aus der klinischen Erfahrung unseres pädiatrischen Zentrums präsentieren und bestimmte Aspekte der publizierten Leitlinie kommentieren. Neben Anamnese und klinischen Symptomen wird vor allem auf die diagnostischen Schritte im Detail eingegangen, die neben radiologischen Untersuchungen, vor allem immunologische Tests, wie den Mendel-Mantoux-Test (MMT), sowie den Interferon-γ Release Assay (IGRA), umfassen. Auch auf die Schwierigkeit der Diagnosestellung im Kindes- und Jugendalter bei unklarer Symptomatik bzw. bei Fehlen eines Indexpatienten wird eingegangen. Neben der Chemoprophylaxe nach Exposition und der Chemoprävention als Behandlung bei latenter TB, werden auch die therapeutischen Optionen bei manifester TB – pulmonal sowie extrapulmonal – diskutiert. Auch die Behandlung der multiresistenten TB, einem zunehmenden klinisch-therapeutischen sowie wirtschaftlichen Problem, wird ebenso thematisiert. Die Zusammenfassung dieser Leitlinie soll eine wertvolle Ergänzung im klinischen Alltag für die Diagnostik und Therapie der TB im Kindes- und Jugendalter im deutschsprachigen Raum darstellen.
ZusammenfassungAktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tub... more ZusammenfassungAktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenüber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Prävention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar.Leitlinien für die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter können nicht generell auf das Kindesalter übertragen werden, da hier relevante altersabhängige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Maßnahmen und der Therapie bestehen.Unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie für die Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adäquate Versorgung von Kindern und Jugendlichen mit...
Summary Background To date, few data on paediatric COVID-19 have been published, and most reports... more Summary Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and in...
Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are ... more Background Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Methods Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. Results A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used...
Europe has the highest documented caseload and greatest increase in multidrug and extensively dru... more Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with >10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by > 2 months. Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop.
American journal of respiratory and critical care medicine, Jan 12, 2015
Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release as... more Latent infection with Mycobacterium tuberculosis is defined by a positive interferon-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low incidence countries of tuberculosis. We analyzed IGRA results and the effect of preventive chemotherapy on tuberculosis progression rates among recent contacts. Results from contact investigations at 26 centers in 10 European countries including testing for latent infection with Mycobacterium tuberculosis by the QuantiFERON-Gold in-Tube (QFT) test or the T-SPOT.TB (TSPOT) were prospectively collected and analyzed. Among 5020 contacts of 1023 index cases, 25 prevalent secondary cases were identified at screening. Twenty-four incident cases occurred among 4513 contacts during 12326 years of cumulative follow-up. In those with a positive IGRA result, tuberculosis incidence was 0.2 (QFT) and 0 (TSPO...
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Papers by Matthias Bogyi