Tuberculosis in Children in Developing Countries: Difference between revisions
No edit summary |
|||
| Line 6: | Line 6: | ||
==Tuberculosis Infection and Transmission== | ==Tuberculosis Infection and Transmission== | ||
Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is a highly contagious disease. | Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is a highly contagious disease. Individuals contract the infection by inhaling tuberculosis bacilli in the air [5]. This bacterium is released through coughing, sneezing, breathing, and talking [5]. Tuberculosis bacteria can remain dormant in the lungs for an extended period of time but never develop into the disease. It is estimated that only 5 to 10% of cases will progress to be infectious or to Tuberculosis disease [5]. Tuberculosis affects children much differently than adults. When a child is infected, they have fewer bacteria in their lungs than an adult with the disease [8]. As a result, it is uncommon for children to infect other individuals with tuberculosis. The microbiology of myocardium tuberculosis makes it very difficult to treat. Since tuberculosis is a gram-positive bacterium, it has a very thick cell wall [8]. Antibiotics must be used for several months in order to break through the thick cell walls and kill the bacteria [8]. When an individual contracts tuberculosis, the body has natural defense mechanisms to combat the infections. Chemicals known as cytokines are released to activate macrophages to kill the tuberculosis bacteria [8]. CD4 cells are also very important for the body to fight this type of infection. HIV destroys CD4 cells, which makes it very easy for and HIV positive individual to contract tuberculosis [8]. There are four main stages in a tuberculosis infection in a child. First, in the primary infection phase, the bacterium invades the cells of the lungs and either spreads or remains latent in the lungs [8]. If the body is able to initiate an immune response, t cells will fight the bacteria in the asymptomatic healing phase. However, in most cases the immune response is not strong enough and the infection moves to the hilar lymph nodes creating symptomatic primary tuberculosis [8]. The next phase of a tuberculosis infection occurs 4 to 5 weeks after the primary infection and is known as symptomatic primary tuberculosis [8]. In this stage, the tuberculosis bacterium causes pleural effusions, pneumonia, and lobar collapse [8]. Depending on the state of the immune system in a child, the tuberculosis can also cause military tuberculosis or tuberculous meningitis [8]. The final stage of the disease is tuberculosis after primary infection [8]. During this period, children are usually free of symptoms but it is still possible for bacteria to be present in the body and cause another tuberculosis infection [8]. | ||
[[Image:Fig_4.jpg|thumb|600px|right| Physical manifestations of tuberculosis in a child. Source Pavithra Logitharajah and Beate Kampmann.]] | [[Image:Fig_4.jpg|thumb|600px|right| Physical manifestations of tuberculosis in a child. Source Pavithra Logitharajah and Beate Kampmann.]] | ||
Revision as of 19:47, 6 December 2009
Edited by Stephanie White
Introduction
Today, tuberculosis is responsible for the death of more young people than any other communicable disease [7]. It is estimated that two children die of a tuberculosis infection every minute [7]. Most Tuberculosis cases are found in low -income regions like Southeast Asia and Africa. Southeast Asia has one of the highest incidence rates of Tuberculosis and contains nearly 34% of all cases worldwide [5]. It is also estimated that in every 100,00 people living in Sub-Saharan Africa 350 are living with Tuberculosis [5]. One factor that contributes to a higher incidence of Tuberculosis cases in low-income countries is HIV and AIDS. Tuberculosis is one of the most deadly opportunistic infections that a person with HIV or AIDS can acquire [5]. Since the immune system of these individuals is compromised, tuberculosis is a common and deadly condition [5]. In most cases, Tuberculosis in children can be traced back to an adult host [3]. The presence of Tuberculosis in children is an important indicator of the overall status of health in a particular country. In many developed nations, Tuberculosis can be treated fairly easily with antibiotics. However, emerging strains of multi-drug resistant stands of Tuberculosis pose a major treat to the health of all populations, especially children. Public health strategies are crucial to controlling Tuberculosis because access in developing countries to effective antibiotics is limited. Children react different to Tuberculosis because their immune systems are still in a developmental state [6]. It is crucial that Tuberculosis in children is carefully controlled in developing countries so that a drug resistant strain does not cause another major worldwide epidemic.
Tuberculosis Infection and Transmission
Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is a highly contagious disease. Individuals contract the infection by inhaling tuberculosis bacilli in the air [5]. This bacterium is released through coughing, sneezing, breathing, and talking [5]. Tuberculosis bacteria can remain dormant in the lungs for an extended period of time but never develop into the disease. It is estimated that only 5 to 10% of cases will progress to be infectious or to Tuberculosis disease [5]. Tuberculosis affects children much differently than adults. When a child is infected, they have fewer bacteria in their lungs than an adult with the disease [8]. As a result, it is uncommon for children to infect other individuals with tuberculosis. The microbiology of myocardium tuberculosis makes it very difficult to treat. Since tuberculosis is a gram-positive bacterium, it has a very thick cell wall [8]. Antibiotics must be used for several months in order to break through the thick cell walls and kill the bacteria [8]. When an individual contracts tuberculosis, the body has natural defense mechanisms to combat the infections. Chemicals known as cytokines are released to activate macrophages to kill the tuberculosis bacteria [8]. CD4 cells are also very important for the body to fight this type of infection. HIV destroys CD4 cells, which makes it very easy for and HIV positive individual to contract tuberculosis [8]. There are four main stages in a tuberculosis infection in a child. First, in the primary infection phase, the bacterium invades the cells of the lungs and either spreads or remains latent in the lungs [8]. If the body is able to initiate an immune response, t cells will fight the bacteria in the asymptomatic healing phase. However, in most cases the immune response is not strong enough and the infection moves to the hilar lymph nodes creating symptomatic primary tuberculosis [8]. The next phase of a tuberculosis infection occurs 4 to 5 weeks after the primary infection and is known as symptomatic primary tuberculosis [8]. In this stage, the tuberculosis bacterium causes pleural effusions, pneumonia, and lobar collapse [8]. Depending on the state of the immune system in a child, the tuberculosis can also cause military tuberculosis or tuberculous meningitis [8]. The final stage of the disease is tuberculosis after primary infection [8]. During this period, children are usually free of symptoms but it is still possible for bacteria to be present in the body and cause another tuberculosis infection [8].
Diagnosis
Diagnosing children for tuberculosis is very difficult because the common sputum smear test often yields a false negative result [1]. It is common for physicians in low-income countries to rely on symptoms for their tuberculosis diagnosis because more advanced test are too expensive [1]. Since the diagnosis of tuberculosis in children is inaccurate, many treatment centers will not accept their cases. When children do not receive a specific treatment plan (DOTS), they rely on any tuberculosis drugs that their families can acquire and afford [1]. This situation is very dangerous for the child and the health of a community because when a child does not receive proper treatment for a tuberculosis infection, it is more likely that a multidrug-resistant strain will emerge [1]. It is crucial that public health institutions implement a strategy for the diagnosis and treatment of tuberculosis in children so that drug resistant cases do not develop and put the entire community at risk.
Treatment
Include some current research in each section.
Public Health Strategies and Case Studies
Include some current research in each section.
Recent research in Africa has confirmed the likelihood that a child will contract pulmonary Tuberculosis if an adult in the household carries the disease. The children were studied in South Africa where there is a low average economic income and high prevalence of Tuberculosis [2]. Initially, 53% of the 125 children were infected with the bacteria but only 11% had developed Tuberculosis disease. [2]. After the 30 month period the number infected with Tuberculosis stayed fairly constant at 54% while the number with the disease rose to 24% [2]. The results proved that children have a 76% chance of being infected with Tuberculosis if they live with an adult with a smear positive Tuberculosis case [2]. During this particular study, treatments for Tuberculosis infection were also studied. The children who had never been treated for a Tuberculosis infection were given a chemoprophylaxis, which is a preventative treatment for Tuberculosis [2]. If a child had received previous chemoprophylaxis treatments, he or she was given a different 4 to 5 drug combination to treat the tuberculosis. The chemoprophylaxis treatment required the child’s parents or caregivers to take them to the clinic 5 days per week for treatment and observed therapy [2]. This kind of treatment proved to be successful because of the 41 children that received chemoprophylaxis treatment, 29 children tested negative for tuberculosis [2]. Public health organizations and workers should promote funding for preventative medications for children because they were effective in protecting children who were continually exposed to tuberculosis. However there are a number of limitations for developing countries in preventing tuberculosis infections. In order for treatment to be effective, parents or caregivers must bring their children to a clinic very frequently which is often difficult due limitations such as type of employment and transportation availability. In addition, many of the drugs required for preventative chemoprophylaxis are quite expensive and their use in developing nations would require funding from a higher income country or non-governmental organization.
Multidrug-resistant tuberculosis in India is becoming a major global health issue because nearly 2 million new cases are detected each year [1]. Many adults have been carefully observed and given short course treatments known as DOTS (directly observed treatment)[1]. However, there has been little done in India to prevent and treat tuberculosis infection in children. It is likely that children in larger cities in India, such as Mumbai, live in overcrowded conditions and are frequently subjected to tuberculosis and multidrug -resistant strains of tuberculosis [1]. Since children often test negative for acid-fast bacilli, it is difficult for public health workers to determine how many are living with tuberculosis [1]. Economic limitations prevent children from receiving more diagnostic tests to determine if they have tuberculosis. Another factor that is affecting the development of multidrug-resistant tuberculosis in children is AIDS. HIV and AIDS make any individual more likely to acquire a tuberculosis infection [1]. Researchers have found that most individuals are not able to purchase antiretroviral therapy for their children but may be able to afford a combination of drugs that help fight tuberculosis [1]. The most common drug mixture includes isoniazid, rifampicin, pyrazinamide, and ethambutol [1]. This treatment option will help prevent tuberculosis from developing in children with HIV or AIDS, but will not protect them from multidrug-resistant tuberculosis [1]. Other public health strategies for the prevention of tuberculosis in children involves steps to reduce the maternal transmission of HIV [ 1]. If the number of pediatric cases of HIV could be reduced, a child’s likelihood of developing tuberculosis would be greatly reduced.
Conclusion
Overall paper length should be approximately 2,000 to 2,500 words.
Include at least two data figures.
Use professional sources, including at least two research studies.
References
[1] "Children and Multi-drug Resistant Tuberculosis in Mumbai (Bombay), India" Centers for Disease Control and Prevention
[2] Schaaf, Simon H., Robert P. Gie, Magdalene Kennedy, Nulda Beyers, Peter B. Hesseling and Peter R. Donald. " Evaluation of Young Children with Adult Multidrug Resistant Tuberculosis: A 30 Month Followup" 2002;109;765-771Pediatrics.
[3] Shingadia D, Novelli V. "Diagnosis and treatment of tuberculosis in children" Department of Academic Child Health, St Barthlomews and The London Medical and Dental School, Queen Mary, University of London, UK
[4] "Tuberculosis" Baylor School of Medicine.
[5] "Tuberculosis" World Health Organization
[6] "TUBERCULOSIS IN A CHILD – SEARCH FOR THE INFECTED ADULT NEARBY" Eurosurveillance
[7] "TB in Children" TB Alert
[8] "Tuberculosis in Children" Student BMJ Archive
Edited by student of Joan Slonczewski for BIOL 191 Microbiology, 2009, Kenyon College.
