Letter to the Editor
Reply to “Tuberculosis in infants less than 3 months of age from Risaralda, Colombia”
Réplica a «Tuberculosis en lactantes menores de 3 meses de Risaralda, Colombia»
Teresa del Rosal Rabes
, Fernando Baquero-Artigao, Ana María Méndez-Echevarría, María José Mellado Peña
Corresponding author
Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales Pediátricas, Hospital Universitario La Paz, Madrid, Spain
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This letter brings to light the difficulties involved in clinical and microbiological diagnosis in these patients. In the case series, 2 infants had a diagnostic delay of more than 3 weeks, and only 3 of the 7 infants under 3 months of age in whom tubercular disease was suspected underwent gastric juice culture.</p><p id="par0010" class="elsevierStylePara elsevierViewall">BCG vaccination, which is performed at birth in Colombia, invalidates the interpretation of the tuberculin test. The new immunological diagnostic tests (IGRAs) are not available in many laboratories and have low sensitivity in small infants. Gastric aspirate culture requires collecting several samples and has low sensitivity compared to sputum culture in adults. However, the diagnostic yield of bacilloscopy and gastric juice culture in infants under 3 months of age exceeds that in older children.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> In addition, microbiological confirmation is considered the gold standard for diagnosing the disease and allows an antibiogram to detect resistant strains to be performed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Colombia has a very high rate of resistance to anti-tuberculosis drugs in children under 15 years of age (21% in 2009), with rates of resistance to isoniazid exceeding 12% and rates of multi-drug resistant strains of 6.5%.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Therefore, we believe that every effort should be made to collect microbiological samples in all patients, especially those with no isolation in the index case.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 3 of the infants studied, the index case was unknown. Our series also found 3 patients with an unknown index case, but with a strong suspicion of maternal genital tuberculosis, as the mothers had a positive tuberculin test, a normal chest X-ray and no identified contact with bacilliferous tuberculosis. Tuberculosis in an infant under 3 months of age involves congenital infection or postnatal transmission from a bacilliferous adult. Therefore, it is essential to conduct a full contact study to prevent the transmission of the disease and the appearance of new cases of tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally, we would like to make a consideration with respect to treatment. All infants were treated according to the regimen recommended in Colombia for children under 15 years of age. This regimen consists of administering 3 drugs (isoniazid, rifampicin and pyrazinamide) for 8 weeks followed by bitherapy with isoniazid and rifampicin 2 times per week until 6 months have elapsed.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> We believe that, given the high rate of resistance, it would be important to start treatment with 4 drugs if the sensitivity of the strain from the child or from the index case is unknown. In addition, we recommend continuing treatment for at least 9 months in infants under 3 months of age with tuberculosis, and extending it up to 12 months in those with meningeal involvement.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">No funding was received to complete this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: del Rosal Rabes T, Baquero-Artigao F, Méndez-Echevarría AM, Mellado Peña MJ. Réplica a «Tuberculosis en lactantes menores de 3 meses de Risaralda, Colombia». Enferm Infecc Microbiol Clin. 2017;35:328–329.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis at extremes of age" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.S. Schaaf" 1 => "A. Collins" 2 => "A. Bekker" 3 => "P.D.O. 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Baquero-Artigao" 1 => "M.J. Mellado Peña" 2 => "T. Del Rosal Rabes" 3 => "A. Noguera Julián" 4 => "A. Goncé Mellgren" 5 => "M. de la Calle Fernández-Miranda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anpedi.2015.01.010" "Revista" => array:2 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2015" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17300977/v1_201705111055/en/main.assets" "Apartado" => array:4 [ "identificador" => "66012" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000005/v1_201705111055/S2529993X17300977/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300977?idApp=UINPBA00004N" ]
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| 2022 June | 10 | 7 | 17 |
| 2022 May | 12 | 4 | 16 |
| 2022 April | 13 | 10 | 23 |
| 2022 March | 22 | 10 | 32 |
| 2022 February | 24 | 6 | 30 |
| 2022 January | 44 | 5 | 49 |
| 2021 December | 26 | 8 | 34 |
| 2021 November | 11 | 8 | 19 |
| 2021 October | 28 | 12 | 40 |
| 2021 September | 9 | 8 | 17 |
| 2021 August | 13 | 9 | 22 |
| 2021 July | 12 | 4 | 16 |
| 2021 June | 12 | 10 | 22 |
| 2021 May | 21 | 9 | 30 |
| 2021 April | 19 | 5 | 24 |
| 2021 March | 16 | 6 | 22 |
| 2021 February | 8 | 7 | 15 |
| 2021 January | 10 | 9 | 19 |
| 2020 December | 16 | 6 | 22 |
| 2020 November | 17 | 10 | 27 |
| 2020 October | 6 | 8 | 14 |
| 2020 September | 4 | 10 | 14 |
| 2020 August | 9 | 7 | 16 |
| 2020 July | 5 | 6 | 11 |
| 2020 June | 6 | 7 | 13 |
| 2020 May | 16 | 12 | 28 |
| 2020 April | 6 | 5 | 11 |
| 2020 March | 7 | 4 | 11 |
| 2020 February | 7 | 9 | 16 |
| 2020 January | 8 | 16 | 24 |
| 2019 December | 15 | 5 | 20 |
| 2019 November | 7 | 4 | 11 |
| 2019 October | 14 | 6 | 20 |
| 2019 September | 8 | 1 | 9 |
| 2019 August | 4 | 3 | 7 |
| 2019 July | 15 | 7 | 22 |
| 2019 June | 16 | 38 | 54 |
| 2019 May | 44 | 31 | 75 |
| 2019 April | 4 | 7 | 11 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 1 | 7 | 8 |
| 2019 January | 2 | 2 | 4 |
| 2018 December | 1 | 3 | 4 |
| 2018 November | 6 | 6 | 12 |
| 2018 October | 7 | 10 | 17 |
| 2018 September | 3 | 1 | 4 |
| 2018 August | 6 | 2 | 8 |
| 2018 July | 5 | 2 | 7 |
| 2018 June | 3 | 1 | 4 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 5 | 2 | 7 |
| 2018 February | 5 | 0 | 5 |
| 2018 January | 6 | 2 | 8 |
| 2017 December | 4 | 0 | 4 |
| 2017 November | 3 | 2 | 5 |
| 2017 October | 6 | 1 | 7 |
| 2017 May | 1 | 0 | 1 |
Show all
