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pediatric tuberculosis an online.presentation for healthcare.professionals produced by the Korea.international tuberculosis Center.written and presented by dr. Anne M.Loffler.I'm dr. Anne Lafleur pediatric.tuberculosis consultant and I look.forward to sharing information about.pediatric TB with you today this.presentation is designed to strengthen.your diagnostic and treatment skills.when you work with children with latent.TB infection also known as L TBI or.tuberculosis disease also known as TB.today we'll cover the three basic.situations in which children are often.evaluated for TB infection or disease.I'll explain how l TB I should be.diagnosed and treated in children and.I'll describe treatment strategies for.TB and children including TB meningitis.and scrofula let's start with the.question why bother to learn about.pediatric TB even though it's my.favorite disease pediatric TB is not on.everyone's top ten list of diseases to.worry about there are some reasons to be.somewhat complacent about pediatric TB.TB is a relatively rare disease in the.United States in 2015 there were only.440 cases of TB in children 0 to 14.years of age that's the lowest case rate.of any age group to put it in.perspective roughly 16,000 children are.diagnosed with cancer each year and over.3,000 children and teens are killed.annually in motor vehicle accidents TB.is pretty uncommon in children living in.the United States next young children.with TB are usually not contagious and.therefore pose a threat only to.themselves in areas where health.resources are very scarce contagious.adults are the focus of TB control.efforts also compared to children adults.with TB are relatively easy to identify.they are more symptomatic and they can.produce sputum which can be easily.examined under a microscope for a rapid.diagnosis of contagious TB children with.TB on the other hand are difficult to.diagnose and are rarely contagious.making paediatric TB a low public health.priority in many parts of the world I.hope I haven't enticed you to go back to.your webserver.spend your time learning about a disease.with higher morbidity there are good.reasons to learn about and appreciate.the nuances of pediatric TB it is.estimated that worldwide each year 1.million children become ill with TB.compared to the US children in.developing countries are.disproportionately burdened with TB in.fact children represent up to 30% of TB.cases globally compared to 5% in the.u.s. even in the u.s. infants and.preschool aged children are more likely.to develop TB once infected and are more.likely to suffer disseminated forms of.TB finally even if you only treat adults.pediatric TB is still an important.subject children with TB or LT bi have.been infected recently so they serve as.indicators of contagious adolescents or.adults in the community with TB finding.and treating TB infected children is a.public health priority in the United.States I hope I've convinced you that.pediatric TB is an interesting and.worthy field of study and I hope you're.ready to learn a lot more depending upon.your job description or frame of.reference there are three general.situations where you might worry about.TB or have reason to evaluate children.for TB infection or disease the tools to.evaluate and the methods of treatment.are different in these three situations.so let's address each situation.individually the first situation is.faced by those providing general.pediatric care to healthy children.healthy children should be screened for.TB risk factors at each well visit this.screening should be done by asking the.family four to six simple questions only.children identified as having new risk.factors for TB exposure should undergo.skin testing the second situation falls.in the purview of public health.providers and TB control programs but is.shared by pediatric providers when a.child is identified as a contact to an.adult with potentially contagious TB.rapid evaluation intervention are.required and finally children sometimes.come to medical attention because they.have signs or symptoms of TB or they.have radiographic changes suggesting TB.the signs and symptoms of TB are subtle.and nonspecific so high index of.suspicion is required the diagnosis of.PD.TB is more art than science but I hope.by the end of this program you'll have a.little more comfort with distinguishing.pediatric TB from the many other.diagnostic possibilities here's a little.quiz of the three situations I just.described which one yields the most.cases of TB and children screening of.healthy asymptomatic children screening.of children exposed to contagious adults.with TB or evaluation of children with.symptoms concerning for TB I'll give you.a little hint the answer is different in.the u.s. compared to developing.countries in the United States 26 to 80.percent of children with TB in various.studies are identified during contact.investigations that is the evaluation of.the folks in contact with a newly.diagnosed TB case three to twenty five.percent of cases are identified by.routine screening and seventeen at forty.four percent of cases presented because.of symptoms in contrast in developing.countries there is no screening of.asymptomatic children children are.identified as having TB only if they're.symptomatic because in many areas skin.testing and chest radiographs are not.available for the next few minutes we.will delve more into the routine.screening and treatment of children in.routine pediatric care relatively few.children are identified with TB as a.result of routine screening so this.process must be quick and cost effective.the tuberculin skin test also known as.the TST is the well known method of.screening for TB infection or disease.however it is not cost effective to.routinely test healthy children without.risk for TB we'll talk more about the.newer blood tests later in this.presentation I'll say it again it is not.cost effective to routinely test healthy.children without risk for TB infection.or disease we now prefer the strategy.called targeted testing which entails.testing only those children more likely.to be exposed to TB the pediatric TB.risk assessment tool is a helpful.resource to assess a child's risk for.latent TB infection it was recently.developed by the California TB control.branch and updates an earlier.questionnaire published in 2004 Y.abandoned the old strategy of universal.skin testing for the new and.move targeted testing first the TST is.only ninety percent sensitive and ninety.percent specific this leads to around.85% of positive results being false.positives in areas with low disease.prevalence false positive results lead.to expensive anxiety producing and.unnecessary evaluations and treatment of.the child and the family.second the test is not free not without.discomfort and not so easy to place and.interpret and finally families often do.not return for skin tests reading this.might be a good time to mention the BCG.vaccine which is given quite routinely.in most areas of the world national.guidelines recommend ignoring the.history of receipt of BCG when placing.or interpreting the TST having said that.if a child received BCG as an older.infinitive child received multiple BCG s.or received a BCG in the recent past it.is more likely that a positive TST.result is in fact due to BCG next I'll.talk about the blood test that might.clarify true positive TST results from.BCG cross reaction one tool for.clarifying the diagnosis of TB infection.is the use of an interferon gamma.release assay or agri because these.tests look for the patient's reaction to.fairly specific TB proteins rather than.a variety of mycobacterial antigens they.are especially appealing for.differentiating true infection from.reaction to prior BCG vaccination there.are two licensed tests in the United.States the quantifier on TB gold tests.and the T spot TB test both tests.incubate the patient's blood with.various TB specific proteins and.controls if the lymphocytes in the blood.have recognized the TB proteins and.produced gamma interferon well above the.control levels the test is deemed to be.positive the quanto fear on incubates.whole blood and measures gamma.interferon in the plasma the following.day by use of an Eliza test the T spot.test incubates only the patient's.lymphocytes and uses an le spot test to.measure gamma interferon production in.most situations the test can distinguish.true TB infections from those caused by.non-tuberculous mycobacteria or BCG.exposure these tests do not measure.antibody response and are therefore not.serologies there are no serologic tests.which have been found to be helpful in.TB diagnostics in addition to improve.specificity other advantages of blood.tests include the fact that the patient.does not need to return to the clinic.for skin tests reading there is also.less subjectivity in interpreting the.blood test result egret tests can be.used interchangeably with tsts starting.at two years of age agra is the.preferred test for children two years.and older who have received BCG or who.are unlikely to come back for skin test.reading icarus are also useful if.additional evidence is needed to assure.adherence for lcbi treatment in some.cases parents are skeptical about their.child's TST results when testing for TB.infection many experts will use a egrant.test even in the youngest children with.the goal of improving specificity that.is avoiding the false positive results.sometimes seen with the TST some experts.do not use in agra in children younger.than two years of age because of the.relative lack of data for this age group.over time we may learn that the iqra'.tests work every bit as well as the TST.even for infants many experts use both.of TST and a Niger test if there is high.concern for TB disease but remember.neither a negative TST nor Agra test.should ever rule out TB disease and.please note throughout this presentation.when I refer to positive or negative TST.results assume I am also referring to it.grow results.

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Tb Risk Assessment Worksheet Attachment A Dhs Sd FAQs

Some of the confused FAQs related to the Tb Risk Assessment Worksheet Attachment A Dhs Sd are:

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I have a class lesson assessment form that I need to have filled out for 75 lessons. The form will be exactly the same except for the course number. How would you do this?

Another way would be to use the option of getting pre-filled answers with the course numbers entered. A custom URL is created and the form would collect the answers for all of the courses in the same spreadsheet. Not sure if that creates another problem for you, but you could sort OR filter the sheet once all the forms had been submitted. This is what the URL would look like for a Text Box https://docs.google.com/forms/d/1Ia6-paRijdUOn8U2L2H0bF1yujktcqgDsdBJQy2yO30/viewform?entry.14965048=COURSE+NUMBER+75 The nice thing about this is you can just change the part of the URL that Contains "COURSE+NUMBER+75" to a different number...SO for course number 1 it would be https://docs.google.com/forms/d/1Ia6-paRijdUOn8U2L2H0bF1yujktcqgDsdBJQy2yO30/viewform?entry.14965048=COURSE+NUMBER+1 This is what the URL would look like for a Text Box radio button, same concept. https://docs.google.com/forms/d/1Ia6-paRijdUOn8U2L2H0bF1yujktcqgDsdBJQy2yO30/viewform?entry.14965048&entry.1934317001=Option+1 OR https://docs.google.com/forms/d/1Ia6-paRijdUOn8U2L2H0bF1yujktcqgDsdBJQy2yO30/viewform?entry.14965048&entry.1934317001=Option+6 The Google Doc would look like this Quora pre-filled form I'm not sure if this helps at all or makes too complicated and prone to mistakes.

What is TB screening questionnaire?

A screening questionnaire is used to determine is someone falls into the groups of people you're studying. I've never used them when recruiting people via a snowball sample, because it was really obvious if people fit in with my study or not. I was interviewing people who worked in marketing, branding and related industries in Beijing. So, if someone I interviewed suggested I talk to a coworker, I knew they fit in with my study. But, let's say you're doing research on people older than 60 who are retired, have a high disposable income and use the internet on a daily basis. Someone might be able to recommend their friends in that age range, but they might not know their disposable income or internet usage habits. That's where a screening questionnaire can quickly figure out if they fit your criteria. Also, if you're compensating people for your interviews you run the risk of people who need the money lying about fitting the criteria. If you say, "I'm looking for people with a high disposable income, is yours above $50k?" they might lie. But, if you just have questions phrased in a way that doesn't reveal what you're looking for, you have a better chance of avoiding that.

What is a tuberculosis risk assessment?

"Scary Situations: What is the creepiest thing that has ever actually happened to you?" When I was sixteen, I almost committed suicide. I can tell you the excuses I had, but I was frustrated, hurt, and feeling unloved, so... This story is not about that, but the experience of my almost suicide gave me a sort of 'borrowed time' idea where I stopped giving a fuck about anybody or anything. So, this was the mood I was in when I set off during my summer vacation for two months vagabonding in Great Britain. I told my parents that I would be gone for a few months and not to worry, then I set off. I had Continue Reading

What is TB risk assessment?

"Scary Situations: What is the creepiest thing that has ever actually happened to you?" When I was sixteen, I almost committed suicide. I can tell you the excuses I had, but I was frustrated, hurt, and feeling unloved, so... This story is not about that, but the experience of my almost suicide gave me a sort of 'borrowed time' idea where I stopped giving a fuck about anybody or anything. So, this was the mood I was in when I set off during my summer vacation for two months vagabonding in Great Britain. I told my parents that I would be gone for a few months and not to worry, then I set off. I had Continue Reading

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