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Roshini Claire Anthony, 5 days ago

The use of a vaginal cleansing intervention prior to Caesarean delivery reduced the incidence of surgical site infections (SSIs), according to a study presented at ACOG 2020. However, the addition of intravenous (IV) azithromycin prophylaxis had no added impact on SSI rates. 

Pank Jit Sin, 21 May 2020

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More emphasis necessary for TB prevention in paediatric population

Dr Joslyn Ngu
12 Sep 2017

A documented household exposure should trigger prompt contact tracing to allow timely diagnosis and to prevent the development of tuberculosis (TB) disease, according to a specialist.

The treatment of latent TB infection (LTBI) in children is fairly safe and effective. Adverse events are relatively uncommon; the most common side effects include nausea and vomiting, said infectious diseases and paediatric consultant Dr. Tan Kah Kee, who was speaking at the Malaysian Thoracic Society (MTS) Annual Congress 2017, held in Kuala Lumpur recently. It is important to educate caregivers to monitor these symptoms, and to assess the child’s clinical symptoms and growth during follow-up, he added.

Traditionally, TB is divided into two distinct states: LTBI and disease. LTBI is the state where the patient is asymptomatic and Mycobacterium tuberculosis is dormant. A tuberculin skin test (TST) will produce a positive result while physical examination and chest X-ray will be normal, said Tan. Management of a patient with an infection will include either an isoniazid monotherapy for 6 months or isoniazid plus rifampicin for 3 months. Conversely, in the TB disease state, the patient is symptomatic and M.  tuberculosis is actively replicating. Similar to the infection state, TST will have a positive result but unlike the infection state, physical examination and chest X-ray will be abnormal in the disease state. Management will require a multiple drug regime, said Tan.

Nevertheless, current TB concept states that both LTBI and the TB disease states may not be the only two states, and that there is a spectrum of immunological responses to a TB infection.  The spectrum includes infection elimination by innate immunity, acquired immune response, early disease with minimal symptoms and advanced clinical TB, Tan explained.

TSTis the preferred investigation test for TB in children. It assesses the degree of hypersensitivity to tuberculin purified protein derivative and the reaction size correlates with the future risk of developing TB disease. If the reaction is bigger than 15 mm, it is unlikely to be due to previous BCG vaccination or exposure to environmental mycobacteria, he explained. More than half of infants who were given BCG at birth will have a non-reactive TST at 9 to 12 months of age. However, a negative TST does not exclude the diagnosis of TB as severe malnutrition, HIV infection, disseminated TB and immunosuppressive drugs can cause false negative results.

It is estimated that as many as one-third of people worldwide have LTBI. The lifetime risk of reactivation for LTBI is around five to 10 percent. Unfortunately, most develop TB disease within the first 5 years after initial infection and the risk increases significantly if the patient has predisposing factors. [WHO. Available at: http://www.who.int/tb/challenges/ltbi/en/. Accessed on 28 July]

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Most Read Articles
Jairia Dela Cruz, 22 Apr 2020
A wristwatch-like device that monitors pulse, breathing and blood oxygen levels of the user allows physicians to provide care remotely both in hospital and nontraditional settings, and may help in the fight against the coronavirus disease 2019 (COVID-19) pandemic.
Roshini Claire Anthony, 5 days ago

The use of a vaginal cleansing intervention prior to Caesarean delivery reduced the incidence of surgical site infections (SSIs), according to a study presented at ACOG 2020. However, the addition of intravenous (IV) azithromycin prophylaxis had no added impact on SSI rates. 

Pank Jit Sin, 21 May 2020

Persons suffering from asthma should pay particular attention to SARS-CoV-2 precautionary measures such as social distancing, regular handwashing, and wearing of masks on top of keeping their asthma in control. This is because data collected so far paints a bleaker picture for asthmatics than the normal population should they catch COVID-19.

Stephen Padilla, 4 days ago
Herd immunity will not work in the novel coronavirus disease (COVID-19), according to an infectious disease expert who addressed over 3,600 primary care physicians (PCP) from Asia Pacific at the inaugural webcast of the MIMS COVID Conversations Series.