Archives of Pediatric Infectious Diseases Archives of Pediatric Infectious Diseases Arch Pediatr Infect Dis http://www.pedinfect.portal.tools 2322-1828 2322-1836 10.5812/pedinfect en jalali 2019 4 26 gregorian 2019 4 26 3 1 TB
en 10.5812/pedinfect.17934 Outcomes in Adolescents Undergoing Treatment for Drug-Resistant Tuberculosis in Cape Town, South Africa, 2008-2013 Outcomes in Adolescents Undergoing Treatment for Drug-Resistant Tuberculosis in Cape Town, South Africa, 2008-2013 research-article research-article Background

There is limited data on outcomes of adolescents with drug-resistant tuberculosis (DR-TB).

Objectives

To describe patient outcomes and factors associated with outcomes of adolescents diagnosed with DR-TB in Khayelitsha, South Africa.

Patients and Methods

A retrospective analysis of data for adolescents aged 10-19 years who were diagnosed with DR-TB between January 2008 and August 2013 was conducted. The proportions of adolescents with treatment success (cure and treatment completion), failure of treatment, those lost from treatment, and those who died were calculated and compared by HIV status. Proportions and odd ratios are presented.

Results

Seventy-one adolescents were diagnosed with DR-TB. Six (8%) were lost to care before treatment could be initiated. The median age of those started on treatment was 18 years (IQR 15.8-18.9). Eighteen (27.7%) were HIV infected. Of the 44 adolescents with final treatment outcomes, 36.4% (n = 16) were successfully treated, 9.1% (n = 4) died, 11.4% (n = 9) failed treatment and 43.2% (n = 19) were lost from treatment (treatment interrupted for ≥ 2 consecutive months). Three of the four patients who died, died within two months of starting therapy. Loss from treatment, and treatment success (cure or treatment completion) did not differ between HIV infected and un-infected adolescents, OR: 2.0, (95% CI 0.56-7.50), P = 0.27; and OR: 1.2 (95% CI 0.37-4.43), P = 0.71, respectively. All five patients who failed treatment and one of those lost from treatment subsequently died. Overall mortality was 12.1/100 person years.

Conclusions

HIV infected and uninfected adolescents with DR-TB experienced poor outcomes with high proportions of mortality, treatment failure and loss from treatment. Mortality occurred early in the treatment period suggesting delayed presentation and/or diagnosis. Innovative and targeted strategies are needed to encourage early presentation and improve adherence to treatment among adolescents.

Background

There is limited data on outcomes of adolescents with drug-resistant tuberculosis (DR-TB).

Objectives

To describe patient outcomes and factors associated with outcomes of adolescents diagnosed with DR-TB in Khayelitsha, South Africa.

Patients and Methods

A retrospective analysis of data for adolescents aged 10-19 years who were diagnosed with DR-TB between January 2008 and August 2013 was conducted. The proportions of adolescents with treatment success (cure and treatment completion), failure of treatment, those lost from treatment, and those who died were calculated and compared by HIV status. Proportions and odd ratios are presented.

Results

Seventy-one adolescents were diagnosed with DR-TB. Six (8%) were lost to care before treatment could be initiated. The median age of those started on treatment was 18 years (IQR 15.8-18.9). Eighteen (27.7%) were HIV infected. Of the 44 adolescents with final treatment outcomes, 36.4% (n = 16) were successfully treated, 9.1% (n = 4) died, 11.4% (n = 9) failed treatment and 43.2% (n = 19) were lost from treatment (treatment interrupted for ≥ 2 consecutive months). Three of the four patients who died, died within two months of starting therapy. Loss from treatment, and treatment success (cure or treatment completion) did not differ between HIV infected and un-infected adolescents, OR: 2.0, (95% CI 0.56-7.50), P = 0.27; and OR: 1.2 (95% CI 0.37-4.43), P = 0.71, respectively. All five patients who failed treatment and one of those lost from treatment subsequently died. Overall mortality was 12.1/100 person years.

Conclusions

HIV infected and uninfected adolescents with DR-TB experienced poor outcomes with high proportions of mortality, treatment failure and loss from treatment. Mortality occurred early in the treatment period suggesting delayed presentation and/or diagnosis. Innovative and targeted strategies are needed to encourage early presentation and improve adherence to treatment among adolescents.

Extensively Drug-Resistant Tuberculosis;Adolescent;Patient Outcome Assessment Extensively Drug-Resistant Tuberculosis;Adolescent;Patient Outcome Assessment http://www.pedinfect.portal.tools/index.php?page=article&article_id=17934 Sizulu Moyo Sizulu Moyo Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa; Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa. Tel: +27-213645490, Fax: +27-213617051 Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa; Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa. Tel: +27-213645490, Fax: +27-213617051 Jennifer Joan Furin Jennifer Joan Furin Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, USA Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, USA Jennifer Hughes Jennifer Hughes Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Johnny Daniels Johnny Daniels Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Leigh Snyman Leigh Snyman Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Odelia Muller Odelia Muller Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Vivian Cox Vivian Cox Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Amir Shroufi Amir Shroufi Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Medecins Sans Frontieres Khayelitsha, Cape Town, South Africa Helen Cox Helen Cox Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
en 10.5812/pedinfect.20766 The History of Tuberculosis and Bacillus Calmette–Guérin Vaccine in Iran The History of Tuberculosis and Bacillus Calmette–Guérin Vaccine in Iran review-article review-article Context

Tuberculosis (TB) disease caused by Mycobacterium tuberculosis (Mtb) remains as one of the leading infectious causes of death and disease throughout the world. The history of tuberculosis as a worldwide fatal illness traces back to antiquity, being a well-known disease in ancient civilizations.

Evidence Acquisition

Presented here, is a brief review of the history of tuberculosis and Bacillus Calmette–Guérin (BCG) vaccine development in the world as well as its historical background in Iran, mainly during the 19th and 20th centuries using a wide range of published information sources until the last months of 2013.

Results

TB causative agent remained unidentified until the last decade of the 19th century, when Robert Koch discovered it. At present, preparation of the BCG vaccine, application of the Mantoux intradermal diagnostic tuberculosis test and administration of proper antituberculosis medications have eventually controlled tuberculosis.

Conclusions

However, despite these significant advancements, tuberculosis remains a major concern, particularly in developing countries including Iran after the emergence of both multidrug-resistant tuberculosis and HIV co-infection.

Context

Tuberculosis (TB) disease caused by Mycobacterium tuberculosis (Mtb) remains as one of the leading infectious causes of death and disease throughout the world. The history of tuberculosis as a worldwide fatal illness traces back to antiquity, being a well-known disease in ancient civilizations.

Evidence Acquisition

Presented here, is a brief review of the history of tuberculosis and Bacillus Calmette–Guérin (BCG) vaccine development in the world as well as its historical background in Iran, mainly during the 19th and 20th centuries using a wide range of published information sources until the last months of 2013.

Results

TB causative agent remained unidentified until the last decade of the 19th century, when Robert Koch discovered it. At present, preparation of the BCG vaccine, application of the Mantoux intradermal diagnostic tuberculosis test and administration of proper antituberculosis medications have eventually controlled tuberculosis.

Conclusions

However, despite these significant advancements, tuberculosis remains a major concern, particularly in developing countries including Iran after the emergence of both multidrug-resistant tuberculosis and HIV co-infection.

Tuberculosis;BCG Vaccine;Iran Tuberculosis;BCG Vaccine;Iran http://www.pedinfect.portal.tools/index.php?page=article&article_id=20766 Fatemeh Fallah Fatemeh Fallah Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Hamed Abdolghafoorian Hamed Abdolghafoorian Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9127905923, Fax: +21-22226941 Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9127905923, Fax: +21-22226941
en 10.5812/pedinfect.18526 Multifocal Dactylitis as a Consequence of Bacillus Calmette-Guérin Vaccination in a Patient With Severe Combined Immunodeficiency: A Case Report Multifocal Dactylitis as a Consequence of Bacillus Calmette-Guérin Vaccination in a Patient With Severe Combined Immunodeficiency: A Case Report case-report case-report Introduction

Bacillus Calmette-Guérin (BCG) vaccine, a live attenuated Mycobacterium bovis strain, is administrated to all newborn infants in endemic regions according to the current World Health Organization (WHO) recommendation.

Case Presentation

We report a 10-month-boy who was a known case of severe combined immunodeficiency (SCID) admitted with multi-focal fusiform painful swelling in his hands. He had undergone bone marrow transplantation 7 weeks before admission. Multidisciplinary management was done to treat this rare post-transplant occurrence of Bacillus Calmette-Guérin complication.

Conclusions

BCG vaccination administrated routinely in Iran, given that of no screening program for primary immune deficiency currently achieved in our country, exact attention to reschedule of immunization programs in suspicious newborn (with primary immune deficiency) always is necessary and is one of the most effective strategy to prevent BCG complication.

Introduction

Bacillus Calmette-Guérin (BCG) vaccine, a live attenuated Mycobacterium bovis strain, is administrated to all newborn infants in endemic regions according to the current World Health Organization (WHO) recommendation.

Case Presentation

We report a 10-month-boy who was a known case of severe combined immunodeficiency (SCID) admitted with multi-focal fusiform painful swelling in his hands. He had undergone bone marrow transplantation 7 weeks before admission. Multidisciplinary management was done to treat this rare post-transplant occurrence of Bacillus Calmette-Guérin complication.

Conclusions

BCG vaccination administrated routinely in Iran, given that of no screening program for primary immune deficiency currently achieved in our country, exact attention to reschedule of immunization programs in suspicious newborn (with primary immune deficiency) always is necessary and is one of the most effective strategy to prevent BCG complication.

Bacillus;Severe Combined Immunodeficiency;Bone Marrow Transplantation Bacillus;Severe Combined Immunodeficiency;Bone Marrow Transplantation http://www.pedinfect.portal.tools/index.php?page=article&article_id=18526 Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Sedigheh Rafiei Tabatabaei Sedigheh Rafiei Tabatabaei Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Amanati Ali Amanati Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Department of Pediatric Infectious Diseases, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Department of Pediatric Infectious Diseases, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Javad Ghoroubi Javad Ghoroubi Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohsen Karami Mohsen Karami Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.20597 Tuberculosis Diagnosis Tuberculosis Diagnosis editorial editorial Tuberculosis; WHO Tuberculosis; WHO http://www.pedinfect.portal.tools/index.php?page=article&article_id=20597 Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Roxana Mansour Ghanaie Roxana Mansour Ghanaie Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122226941, Fax: +98-2122226941 Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122226941, Fax: +98-2122226941 Farideh Shiva Farideh Shiva Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.17814 Susceptibility Pattern of Bacille Calmette-Guerin Strains Against Pyrazinamide and Other Major Anti-Mycobacterial Drugs Susceptibility Pattern of Bacille Calmette-Guerin Strains Against Pyrazinamide and Other Major Anti-Mycobacterial Drugs research-article research-article Background

BCG (Bacille Calmette-Guerin) vaccine is an attenuated live vaccine administered to prevent Tuberculosis. Disseminated infection due to BCG is a rare life threatening complication of this vaccine, especially in immunocompromised patients.

Objectives

The current study evaluated the sensitivity pattern of the BCG strain supplied by the Institute de Pasteur, Iran against anti-mycobacterial drugs used to treat disseminated infection caused by the vaccine.

Conclusions

The current study findings revealed that Mycobacterium bovis resistance to pyrazinamide is resolved by increasing the concentration of the drug and combining PZA with other anti-mycobacterial agents.

Results

All samples of BCG strain were resistant to most of the anti-mycobacterial drugs used separately except for concentrations of isoniazid 1 µg/mL, ethambutol 3 µg/mL, ciprofloxacin 4 µg/mL and clarithromycin 2 µg/mL. Addition of pyrazinamide (PZA) 25 µg/mL, the susceptibility pattern did not change to any drug , but increasing PZA concentration to 50 µg/ml and combining it with ethionamide 2 µg/mL, isoniazid 0.2 µg/mL, streptomycin 2 µg/mL, rifampin 0.5 µg/mL or ciprofloxacin 0.2 µg/mL, made the Mycobacterium strains susceptible.

Patients and Materials

Bacille Calmette-Guerin strain ATCC 1173 P was purchased from the Pasteur Institute in Tehran and three samples of Mycobacterium bovis isolated from subaxillary adenitis of three patients were tested for susceptibility to major anti-mycobacterial drugs by MODS (microscopic observation drug sensitivity) method.

Background

BCG (Bacille Calmette-Guerin) vaccine is an attenuated live vaccine administered to prevent Tuberculosis. Disseminated infection due to BCG is a rare life threatening complication of this vaccine, especially in immunocompromised patients.

Objectives

The current study evaluated the sensitivity pattern of the BCG strain supplied by the Institute de Pasteur, Iran against anti-mycobacterial drugs used to treat disseminated infection caused by the vaccine.

Conclusions

The current study findings revealed that Mycobacterium bovis resistance to pyrazinamide is resolved by increasing the concentration of the drug and combining PZA with other anti-mycobacterial agents.

Results

All samples of BCG strain were resistant to most of the anti-mycobacterial drugs used separately except for concentrations of isoniazid 1 µg/mL, ethambutol 3 µg/mL, ciprofloxacin 4 µg/mL and clarithromycin 2 µg/mL. Addition of pyrazinamide (PZA) 25 µg/mL, the susceptibility pattern did not change to any drug , but increasing PZA concentration to 50 µg/ml and combining it with ethionamide 2 µg/mL, isoniazid 0.2 µg/mL, streptomycin 2 µg/mL, rifampin 0.5 µg/mL or ciprofloxacin 0.2 µg/mL, made the Mycobacterium strains susceptible.

Patients and Materials

Bacille Calmette-Guerin strain ATCC 1173 P was purchased from the Pasteur Institute in Tehran and three samples of Mycobacterium bovis isolated from subaxillary adenitis of three patients were tested for susceptibility to major anti-mycobacterial drugs by MODS (microscopic observation drug sensitivity) method.

Mycobacterium bovis;Pyrazinamide;Resistance Mycobacterium bovis;Pyrazinamide;Resistance http://www.pedinfect.portal.tools/index.php?page=article&article_id=17814 Seyed Alireza Fahimzad Seyed Alireza Fahimzad Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mahmood Ghasemi Mahmood Ghasemi Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran Farideh Shiva Farideh Shiva Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Keyghobad Ghadiri Keyghobad Ghadiri Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran Masoumeh Navidinia Masoumeh Navidinia Department of Laboratory Sciences, Paramedical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Laboratory Sciences, Paramedical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2122226941 Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2122226941
en 10.5812/pedinfect.18098 Antimicrobial Effects of Folk Medicinal Plants From the North of Iran Against Mycobacterium tuberculosis Antimicrobial Effects of Folk Medicinal Plants From the North of Iran Against <italic>Mycobacterium tuberculosis</italic> research-article research-article Background

Medicinal plants have been used traditionally in Golestan province (north of Iran), against Mycobacterium tuberculosis or the clinical signs of tuberculosis (TB).

Objectives

This study aimed to define the inhibitory effects of ethanolic extracts of six of these medicinal plants against Mycobacterium tuberculosis.

Materials and Methods

Peganum harmala (seed extract), Punica granatum (peel extract), Digitalis sp. (leaf extract), fruit extract of Citrus lemon, Rosa canina and Berberis vulgaris were extracted in ethanol and their activity against M. tuberculosis isolates were determined by the agar diffusion method. The zone of inhibition (at 200 to 1.6 mg/mL) was measured and the results were compared with isoniazid and rifampin as standard positive controls. Also the concentration of vitamin C of each the extracts was evaluated.

Results

The ethanolic extract of Peganum harmala seed and Punica granatum peel exhibited potential activity against all M. tuberculosis isolates with mean inhibitory zone of 18.7 and 18.8 mm, at 200 mg/mL concentration. The mean inhibitory zone around isoniazid and rifampinwere 19.2 and 18.8 mm. Ethanolic extract of Citrus lemon showed moderate inhibitory activity only against sensitive (non MDR; non multi drug resistant) strains of M. tuberculosis, and Digitalis sp. showed inhibitory effects on five isolates. Ascorbic acid content was 43.3 mg/dL in Punica granatum and Digitalis sp. and only 9.1 mg/dL in ethanolic extract of Peganum harmala.

Conclusions

The highest content of vitamin C was observed in the extract of Punica granatum, which was observed to be highly active against Mycobacterium tuberculosis, while the P. harmala must have contained other phytochemical constituents that contributed to the anti-tuberculosis effects of this plant. Our findings showed that ethanolic extracts of P. granatum and P. harmala had anti-TB effects comparable to isoniazid and rifampin and can be good candidates for novel and safe natural products against tuberculosis.

Background

Medicinal plants have been used traditionally in Golestan province (north of Iran), against Mycobacterium tuberculosis or the clinical signs of tuberculosis (TB).

Objectives

This study aimed to define the inhibitory effects of ethanolic extracts of six of these medicinal plants against Mycobacterium tuberculosis.

Materials and Methods

Peganum harmala (seed extract), Punica granatum (peel extract), Digitalis sp. (leaf extract), fruit extract of Citrus lemon, Rosa canina and Berberis vulgaris were extracted in ethanol and their activity against M. tuberculosis isolates were determined by the agar diffusion method. The zone of inhibition (at 200 to 1.6 mg/mL) was measured and the results were compared with isoniazid and rifampin as standard positive controls. Also the concentration of vitamin C of each the extracts was evaluated.

Results

The ethanolic extract of Peganum harmala seed and Punica granatum peel exhibited potential activity against all M. tuberculosis isolates with mean inhibitory zone of 18.7 and 18.8 mm, at 200 mg/mL concentration. The mean inhibitory zone around isoniazid and rifampinwere 19.2 and 18.8 mm. Ethanolic extract of Citrus lemon showed moderate inhibitory activity only against sensitive (non MDR; non multi drug resistant) strains of M. tuberculosis, and Digitalis sp. showed inhibitory effects on five isolates. Ascorbic acid content was 43.3 mg/dL in Punica granatum and Digitalis sp. and only 9.1 mg/dL in ethanolic extract of Peganum harmala.

Conclusions

The highest content of vitamin C was observed in the extract of Punica granatum, which was observed to be highly active against Mycobacterium tuberculosis, while the P. harmala must have contained other phytochemical constituents that contributed to the anti-tuberculosis effects of this plant. Our findings showed that ethanolic extracts of P. granatum and P. harmala had anti-TB effects comparable to isoniazid and rifampin and can be good candidates for novel and safe natural products against tuberculosis.

Medicinal Plants;Mycobacterium tuberculosis;Vitamin C;In Vitro Medicinal Plants;Mycobacterium tuberculosis;Vitamin C;In Vitro http://www.pedinfect.portal.tools/index.php?page=article&article_id=18098 Shadi Jahanpour Shadi Jahanpour Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Kiumars Ghazisaidi Kiumars Ghazisaidi Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Homa Davoodi Homa Davoodi Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Masoumeh Mazandarani Masoumeh Mazandarani Islamic Azad University, Gorgan Branch, Gorgan, IR Iran Islamic Azad University, Gorgan Branch, Gorgan, IR Iran Motahare Samet Motahare Samet Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Nadia Jahanpour Nadia Jahanpour Islamic Azad University, Lahijan Branch, Lahijan, IR Iran Islamic Azad University, Lahijan Branch, Lahijan, IR Iran Ezzat Allah Ghaemi Ezzat Allah Ghaemi Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran; Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-9113711770, Fax: +98-1732245597 Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran; Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-9113711770, Fax: +98-1732245597
en 10.5812/pedinfect.22542 Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis rapid-communication rapid-communication

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are increasing globally. Treatment options for these patients are very limited. Although treatment of these patients with standardized regimen is associated with high mortality and morbidity, rational usage of new drugs might be promising. In this study we will review epidemiology of XDR-TB and TDR-TB in Iran and the world.

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are increasing globally. Treatment options for these patients are very limited. Although treatment of these patients with standardized regimen is associated with high mortality and morbidity, rational usage of new drugs might be promising. In this study we will review epidemiology of XDR-TB and TDR-TB in Iran and the world.

XDR-TB;Tuberculosis;TDR XDR-TB;Tuberculosis;TDR http://www.pedinfect.portal.tools/index.php?page=article&article_id=22542 Payam Tabarsi Payam Tabarsi Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2126109590 ; Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2126109590 ; Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Davood Yadegarinia Davood Yadegarinia Iranian Infectious Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Iranian Infectious Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.22997 Drug-Resistant Tuberculosis and Group 5 Anti-Tuberculosis Drugs Drug-Resistant Tuberculosis and Group 5 Anti-Tuberculosis Drugs editorial editorial Multi-Drug Resistant Tuberculosis;Extensively Drug-Resistant Tuberculosis Multi-Drug Resistant Tuberculosis;Extensively Drug-Resistant Tuberculosis http://www.pedinfect.portal.tools/index.php?page=article&article_id=22997 Shervin Shokouhi Shervin Shokouhi Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9141491958, Fax: +98 21 55416170 Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9141491958, Fax: +98 21 55416170 Ilad Alavi Darazam Ilad Alavi Darazam Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Alimoradian Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Alimoradian Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran
en 10.5812/pedinfect.22368 New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article review-article review-article Conclusions

Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for the comparison of these tests.

Context

It has been estimated that one-third of the world’s population are suffering from latent tuberculosis infection (LTBI). In order to control tuberculosis in high-risk groups proper diagnosis and treatment is essential.

Evidence Acquisition

Useless and expensive tests such as unfocused population-based tests can lead to futile and unnecessary treatments. Targeted screening approaches and individualization of LTBI treatment protocols must be a priority.

Results

Diagnostic methods with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) can accurately detect LTBI. However, interferon-gamma release assays have higher specificity than TST in Bacille Camette-Gurin (BCG)-vaccinated populations; both tests are precise to identify latent tuberculosis. However, it is of great concern that both tests have insignificant roles in predicting risk of progression to active tuberculosis.

Conclusions

Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for the comparison of these tests.

Context

It has been estimated that one-third of the world’s population are suffering from latent tuberculosis infection (LTBI). In order to control tuberculosis in high-risk groups proper diagnosis and treatment is essential.

Evidence Acquisition

Useless and expensive tests such as unfocused population-based tests can lead to futile and unnecessary treatments. Targeted screening approaches and individualization of LTBI treatment protocols must be a priority.

Results

Diagnostic methods with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) can accurately detect LTBI. However, interferon-gamma release assays have higher specificity than TST in Bacille Camette-Gurin (BCG)-vaccinated populations; both tests are precise to identify latent tuberculosis. However, it is of great concern that both tests have insignificant roles in predicting risk of progression to active tuberculosis.

Latent Tuberculosis;Interferon-gamma Release Tests;BCG Latent Tuberculosis;Interferon-gamma Release Tests;BCG http://www.pedinfect.portal.tools/index.php?page=article&article_id=22368 Masoud Mardani Masoud Mardani Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences,Tehran, IR Iran Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences,Tehran, IR Iran Zahra Abtahian Zahra Abtahian Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences,Tehran, IR Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439963-8, Fax: +98-2122439964, Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences,Tehran, IR Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122439963-8, Fax: +98-2122439964,
en 10.5812/pedinfect.22995 Tuberculosis Lymphadenitis in Association With Celiac Disease Mimicking Kikuchi-Fujimoto Disease Tuberculosis Lymphadenitis in Association With Celiac Disease Mimicking Kikuchi-Fujimoto Disease case-report case-report Case Presentation

We presented a case of TB lymphadenitis in association with celiac disease that mimicked KFD in a young child.

Conclusions

Celiac disease, also known as gluten-sensitive enteropathy and nontropical sprue, is an autoimmune disease with chronic inflammation of small intestine, which is associated with increased risk of TB infection. TB lymphadenitis can mimic KFD. Therefore, in each case of unusual lymphadenitis, TB should be considered and if it is associated with failure to thrive, celiac disease should be suspected.

Introduction

Kikuchi-Fujimoto disease (KFD) is an uncommon idiopathic self-limited cause of lymphadenitis that most commonly presents with cervical lymphadenopathy with or without systemic signs and symptom, which is also called histiocytic necrotizing lymphadenitis (1-6). Although infection and autoimmune etiology have been suggested, the cause of KFD is unknown. Several features that support a role for an infectious cause include the generally self-limited courses and association with symptoms similar to upper respiratory tract infection. Many viral infections have been proposed including cytomegalovirus, varicella zoster virus, human herpes virus, Epstein-Barr virus, parainfluenza virus, parvovirus B19, paramyxovirus, Yersinia enterocolitica, and Toxoplasma gondii. In a Korean study on 147 patients presenting at an outpatient clinic, KFD (34.7%) and tuberculous (TB) adenitis (22.4%) were the most common causes of cervical adenitis (7-14).

Case Presentation

We presented a case of TB lymphadenitis in association with celiac disease that mimicked KFD in a young child.

Conclusions

Celiac disease, also known as gluten-sensitive enteropathy and nontropical sprue, is an autoimmune disease with chronic inflammation of small intestine, which is associated with increased risk of TB infection. TB lymphadenitis can mimic KFD. Therefore, in each case of unusual lymphadenitis, TB should be considered and if it is associated with failure to thrive, celiac disease should be suspected.

Introduction

Kikuchi-Fujimoto disease (KFD) is an uncommon idiopathic self-limited cause of lymphadenitis that most commonly presents with cervical lymphadenopathy with or without systemic signs and symptom, which is also called histiocytic necrotizing lymphadenitis (1-6). Although infection and autoimmune etiology have been suggested, the cause of KFD is unknown. Several features that support a role for an infectious cause include the generally self-limited courses and association with symptoms similar to upper respiratory tract infection. Many viral infections have been proposed including cytomegalovirus, varicella zoster virus, human herpes virus, Epstein-Barr virus, parainfluenza virus, parvovirus B19, paramyxovirus, Yersinia enterocolitica, and Toxoplasma gondii. In a Korean study on 147 patients presenting at an outpatient clinic, KFD (34.7%) and tuberculous (TB) adenitis (22.4%) were the most common causes of cervical adenitis (7-14).

Kikuchi Disease;Celiac Disease;Tuberculous Lymphadenitis;Necrotizing Lymphangitis;Young Child Kikuchi Disease;Celiac Disease;Tuberculous Lymphadenitis;Necrotizing Lymphangitis;Young Child http://www.pedinfect.portal.tools/index.php?page=article&article_id=22995 Naghi Dara Naghi Dara Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, P. O. Box: 15468-15514, Tehran, IR Iran. Tel: +98-2122227028, Fax: +98-2122909128, Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, P. O. Box: 15468-15514, Tehran, IR Iran. Tel: +98-2122227028, Fax: +98-2122909128, Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Farid Imanzadeh Farid Imanzadeh Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Amanati Ali Amanati Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Akbar Sayyari Ali Akbar Sayyari Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Pediatric Gastroenterohepatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Peyman Eshghi Peyman Eshghi Department of Pediatric Hematology Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Pediatric Hematology Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran