Doctors call for change in how non-active TB in immigrant children treated
March 2, 2009New guidelines proposed in the March 2009 issue of the journal Pediatrics by researchers from the Indiana University School of Medicine and Riley Hospital for Children may have a major impact on how U.S. pediatricians and family physicians treat non-active tuberculosis (TB) in children who are immigrants, internationally adopted or refugees. The researchers say the strategy should improve the health of this growing number of children and save healthcare dollars.
An estimated one-third of the world's men, women and children have TB. Most cases are non-active ones (also called latent) in which individuals have the TB bacteria in their body but their immune system keeps it in check. While they are not actively sick they are at risk of developing active TB and spreading the disease.
Young children under age 5 with non-active TB have a higher rate of developing the active disease than adults. Estimates indicate that between 10 percent and 20 percent of these children will go on to develop active TB. To prevent this from happening, children with latent TB are treated with medication.
"As a pediatrician in the International Adoption Clinic at Riley Hospital, I see patients with non-active TB on a daily basis. These children come from around the world, many from Russia and other countries of the former Soviet Union, China and Vietnam. The children have often lived in crowded conditions in orphanages -- the type of setting where TB is especially common. These are also among the countries where many TB cases have become resistant to the drug isoniazid. Yet standard U.S. treatment guidelines call for us to use this drug for all latent TB infections in children," said Maria Finnell, M.D., first author of the study.
Using sophisticated computer modeling, Dr. Finnell, who is a pediatrics fellow, and her Riley Hospital co-authors John C. Christenson, M.D., IU School of Medicine professor of clinical pediatrics and an infectious disease specialist, and Stephen M. Downs, M.D., IU School of Medicine associate professor of pediatrics and a Regenstrief Institute affiliated scientist, determined that treatment guidelines need to be changed so that children with non-active TB who come to the U.S. from countries with high rates of isoniazid resistance are treated with another drug called rifampin. Rifampin currently is used only in children exposed to known cases of isoniazid resistant TB.
"As we can't find the actual bacteria in patients with non-active TB, we have no way of knowing which children have the isoniazid-resistant strain. Our analysis shows that for those with latent TB who come from countries with isoniazid-resistant rates above 11 percent, treatment with rifampin would be cost-effective. Even though rifampin is a more expensive drug than isoniazid, we would lower total costs because using rifampin would prevent more cases of active TB. As an added benefit, the course of rifampin is six months rather than the nine months of therapy required for isoniazid, which may improve adherence. In parts of the world, more than 40 percent of the active TB cases are now isoniazid resistant. We need to consider where a child came from, what the rate of resistance is in that country, and tailor the medication to that," said Dr. Finnell.
According to Dr. Finnell, there has been no previous analysis of this type for pediatric non-active TB patients, although similar analyses have been done for adults. And she notes that the benefits of treating non-active TB far exceed the minimal risk of side effect in children.
Source: Indiana University
-
US recommends routine HPV vaccination for boys
Feb 03, 2012 |
5 / 5 (1) |
0
-
Schooling protects fleeing children from disease
Feb 03, 2012 |
not rated yet |
0
-
Imaging study shows how humor activates kids' brain regions
Feb 01, 2012 |
5 / 5 (2) |
0
-
Senator's stroke shows they can hit the young, too
Jan 30, 2012 |
not rated yet |
0
-
Multitasking may harm the social and emotional development of tweenage girls, researchers say
Jan 27, 2012 |
4.3 / 5 (3) |
0
-
Engineers build first sub-10-nm carbon nanotube transistor
Feb 01, 2012 |
4.9 / 5 (33) |
30
-
Something old, something new: Evolution and the structural divergence of duplicate genes
Jan 31, 2012 |
4.6 / 5 (7) |
1
-
The hidden nanoworld of ice crystals: Revealing the dynamic behavior of quasi-liquid layers
Jan 30, 2012 |
5 / 5 (4) |
1
-
Stock market network reveals investor clustering
Jan 27, 2012 |
3.9 / 5 (23) |
8
-
Of microchemistry and molecules: Electronic microfluidic device synthesizes biocompatible probes
Jan 26, 2012 |
5 / 5 (2) |
0
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
Starve a virus, feed a cure? Findings show how some cells protect themselves against HIV
A protein that protects some of our immune cells from the most common and virulent form of HIV works by starving the virus of the molecular building blocks that it needs to replicate, according to research published online ...
3 hours ago |
5 / 5 (1) |
0
|
Injured boomers beware: Know when to see doctor
(AP) -- It happened to nurse Jane Byron years after an in-line skating fall, business owner Haralee Weintraub while doing "men's" push-ups, and avid cyclist Gene Wilberg while lifting a heavy box.
4 hours ago |
5 / 5 (1) |
0
FDA-approved drug rapidly clears amyloid from the brain, reverses Alzheimer's symptoms in mice
Neuroscientists at Case Western Reserve University School of Medicine have made a dramatic breakthrough in their efforts to find a cure for Alzheimer's disease. The researchers' findings, published in the journal Science, show t ...
Medicine & Health / Neuroscience
Feb 09, 2012 |
4.9 / 5 (56) |
15
|
Green tea found to reduce disability in the elderly
(Medical Xpress) -- A lot of research has been done over the past several years looking into the health benefits of green tea. As a result, scientists have found that regular consumption of the beverage leads ...
Teen school drop-outs three times as likely to be on benefits in later life
Teen school drop-outs are almost three times as likely to be on benefits in later life as their peers who complete their schooling, indicates research published online in the Journal of Epidemiology and Community Health.
Feb 06, 2012 |
not rated yet |
13
Scientists discover molecular secrets of 2,000-year-old Chinese herbal remedy
For roughly two thousand years, Chinese herbalists have treated Malaria using a root extract, commonly known as Chang Shan, from a type of hydrangea that grows in Tibet and Nepal. More recent studies suggest that halofuginone, ...
New method to examine batteries -- MRI from the inside
There is an ever-increasing need for advanced batteries for portable electronics, such as phones, cameras, and music players, but also to power electric vehicles and to facilitate the distribution and storage of energy derived ...
Google might launch Drive for cloud storage soon
(PhysOrg.com) -- Google's next big move, according to the Wall Street Journal, is a cloud storage service called Drive. Hardly first to the plate, Google is simply catching up to introducing its cloud reposi ...
Lab study raises questions over nano-particle impact
Tests involving chickens have raised questions about the impact on health from engineered nano-particles, the ultra-fine grains commonly used in drugs and processed foods, scientists said on Sunday.
A mitosis mystery solved: How chromosomes align perfectly in a dividing cell
Although the process of mitotic cell division has been studied intensely for more than 50 years, Whitehead Institute researchers have only now solved the mystery of how cells correctly align their chromosomes during symmetric ...
Researchers find extensive RNA editing in human transcriptome
In a new study published online in Nature Biotechnology, researchers from BGI, the world's largest genomics organization, reported the evidence of extensive RNA editing in a human cell line by analysis of RNA-seq data, demons ...