Conference Material > Abstract
Josaphat A, Saldanha AM, Mwanga JP, Simon A
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/ttb5-d359
INTRODUCTION
Tuberculosis (TB) and severe acute malnutrition (SAM) are major health problems in east Democratic Republic Congo (DRC), a setting with persistent armed conflict and population displacement. Diagnosis of TB in children is difficult as symptoms are non-specific and diagnostic sensitivity is low, especially in SAM.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-year old girl was referred for a 2-week history of fever, cough, weight loss, and swelling of the limbs and face. On examination she was febrile and tachycardic, with pedal edema up to the knee, facial puffiness, and bilateral crepitations on auscultation. She lived in an overcrowded camp for internally displaced people. Her older brother had similar symptoms and neighbours had recently started TB treatment. She was admitted with a working diagnosis of SAM-Kwashiorkor type, acute pneumonia, and suspicion of TB. At day 5, her fevers continued despite IV broad-spectrum antibiotics. Chest x-ray was insignificant. Sputum microscopy and GeneXpert on gastric aspirate were both negative for TB. She developed abdominal distension and a spontaneous fistula at the umbilicus (photo), discharging milky fluid that was thought to be digested nutritional milk. Anti-tuberculosis treatment was started based on strong clinical suspicion of extra-pulmonary TB (EPTB). Within 2 weeks she improved clinically and nutritionally, the fistula spontaneously closed eliminating the need for surgery, and she could be discharged.
DISCUSSION
This case highlights the difficulties of diagnosing EPTB in children with SAM. Diagnosis relies heavily on clinical suspicion and epidemiological information. Negative sputum microscopy and GeneXpert gastric aspirate analysis do not rule out TB. Early initiation of treatment is the most important factor affecting mortality, thus empirically starting treatment should be considered. Spontaneous enterocutaneous fistulas caused by TB are rare, and there is limited literature describing their presentation or treatment. In our case, an empiric conservative treatment approach was very successful and even eliminated the need for surgery.
Tuberculosis (TB) and severe acute malnutrition (SAM) are major health problems in east Democratic Republic Congo (DRC), a setting with persistent armed conflict and population displacement. Diagnosis of TB in children is difficult as symptoms are non-specific and diagnostic sensitivity is low, especially in SAM.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-year old girl was referred for a 2-week history of fever, cough, weight loss, and swelling of the limbs and face. On examination she was febrile and tachycardic, with pedal edema up to the knee, facial puffiness, and bilateral crepitations on auscultation. She lived in an overcrowded camp for internally displaced people. Her older brother had similar symptoms and neighbours had recently started TB treatment. She was admitted with a working diagnosis of SAM-Kwashiorkor type, acute pneumonia, and suspicion of TB. At day 5, her fevers continued despite IV broad-spectrum antibiotics. Chest x-ray was insignificant. Sputum microscopy and GeneXpert on gastric aspirate were both negative for TB. She developed abdominal distension and a spontaneous fistula at the umbilicus (photo), discharging milky fluid that was thought to be digested nutritional milk. Anti-tuberculosis treatment was started based on strong clinical suspicion of extra-pulmonary TB (EPTB). Within 2 weeks she improved clinically and nutritionally, the fistula spontaneously closed eliminating the need for surgery, and she could be discharged.
DISCUSSION
This case highlights the difficulties of diagnosing EPTB in children with SAM. Diagnosis relies heavily on clinical suspicion and epidemiological information. Negative sputum microscopy and GeneXpert gastric aspirate analysis do not rule out TB. Early initiation of treatment is the most important factor affecting mortality, thus empirically starting treatment should be considered. Spontaneous enterocutaneous fistulas caused by TB are rare, and there is limited literature describing their presentation or treatment. In our case, an empiric conservative treatment approach was very successful and even eliminated the need for surgery.
Journal Article > ResearchAbstract Only
J Vector Borne Dis. 2021 July 1; DOI:10.4103/0972-9062.321747
Mahajan R, Nair MM, Saldanha AM, Harshana A, de Lima Pereira A, et al.
J Vector Borne Dis. 2021 July 1; DOI:10.4103/0972-9062.321747
BACKGROUND AND OBJECTIVES
There is limited evidence regarding the accuracy of dengue rapid diagnostic kits despite their extensive use in India. We evaluated the performance of four immunochromatographic Rapid Diagnostic Test (RDTs) kits: Multisure dengue Ab/Ag rapid test (MP biomedicals; MP), Dengucheck combo (Zephyr Biomedicals; ZB), SD bioline dengue duo (Alere; SD) and Dengue day 1 test (J Mitra; JM).
METHODS
This is a laboratory-based diagnostic evaluation study. Rapid tests results were compared to reference non-structural (NS1) antigen or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) results of 241 dengue-positive samples and 247 dengue-negative samples. Sensitivity and specificity of NS1 and IgM components of each RDT were calculated separately and in combination (either NS1 or IgM positive) against reference standard ELISA.
RESULTS
A total of 238, 226, 208, and 146 reference NS1 ELISA samples were tested with MP, ZB, SD, and JM tests, respectively. In comparison to the NS1 ELISA reference tests, the NS1 component of MP, ZB, SD, and JM RDTs demonstrated a sensitivity of 71.8%, 85.1%, 77.2% and 80.9% respectively and specificity of 90.1%, 92.8%, 96.1 %, and 93.6%, respectively. In comparison to the IgM ELISA reference test, the IgM component of RDTs showed a sensitivity of 40.0%, 50.3%, 47.3% and 20.0% respectively and specificity of 92.4%, 88.6%, 96.5%, and 92.2% respectively. Combining NS1 antigen and IgM antibody results led to sensitivities of 87.5%, 82.9%, 93.8% and 91.7% respectively, and specificities of 75.3%, 73.9%, 76.5%, and 80.0% respectively.
INTERPRETATION & CONCLUSIONS
Though specificities were acceptable, the sensitivities of each test were markedly lower than manufacturers' claims. These results also support the added value of combined antigen-and antibody-based RDTs for the diagnosis of acute dengue.
There is limited evidence regarding the accuracy of dengue rapid diagnostic kits despite their extensive use in India. We evaluated the performance of four immunochromatographic Rapid Diagnostic Test (RDTs) kits: Multisure dengue Ab/Ag rapid test (MP biomedicals; MP), Dengucheck combo (Zephyr Biomedicals; ZB), SD bioline dengue duo (Alere; SD) and Dengue day 1 test (J Mitra; JM).
METHODS
This is a laboratory-based diagnostic evaluation study. Rapid tests results were compared to reference non-structural (NS1) antigen or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) results of 241 dengue-positive samples and 247 dengue-negative samples. Sensitivity and specificity of NS1 and IgM components of each RDT were calculated separately and in combination (either NS1 or IgM positive) against reference standard ELISA.
RESULTS
A total of 238, 226, 208, and 146 reference NS1 ELISA samples were tested with MP, ZB, SD, and JM tests, respectively. In comparison to the NS1 ELISA reference tests, the NS1 component of MP, ZB, SD, and JM RDTs demonstrated a sensitivity of 71.8%, 85.1%, 77.2% and 80.9% respectively and specificity of 90.1%, 92.8%, 96.1 %, and 93.6%, respectively. In comparison to the IgM ELISA reference test, the IgM component of RDTs showed a sensitivity of 40.0%, 50.3%, 47.3% and 20.0% respectively and specificity of 92.4%, 88.6%, 96.5%, and 92.2% respectively. Combining NS1 antigen and IgM antibody results led to sensitivities of 87.5%, 82.9%, 93.8% and 91.7% respectively, and specificities of 75.3%, 73.9%, 76.5%, and 80.0% respectively.
INTERPRETATION & CONCLUSIONS
Though specificities were acceptable, the sensitivities of each test were markedly lower than manufacturers' claims. These results also support the added value of combined antigen-and antibody-based RDTs for the diagnosis of acute dengue.
Conference Material > Slide Presentation
Josaphat A, Saldanha AM, Mwanga JP, Simon A
MSF Paediatric Days 2022. 2022 December 1; DOI:10.57740/17gw-fm44
Français