Publications
39 results found
Golwala Z, Pandey A, Roy RB, 2022, The art of medicine "You have not remained the same, nor have I", LANCET, Vol: 400, Pages: 485-486, ISSN: 0140-6736
Thee S, Roy RB, Blazquez-Gamero D, et al., 2022, Treatment and Outcome in Children With Tuberculous Meningitis: A Multicenter Pediatric Tuberculosis Network European Trials Group Study, CLINICAL INFECTIOUS DISEASES, Vol: 75, Pages: 372-381, ISSN: 1058-4838
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- Citations: 6
Olbrich L, Stockdale L, Basu Roy R, et al., 2021, Understanding the interaction between cytomegalovirus and tuberculosis in children: The way forward, PLoS Pathogens, Vol: 17, Pages: 1-21, ISSN: 1553-7366
Over 1 million children develop tuberculosis (TB) each year, with a quarter dying. Multiple factors impact the risk of a child being exposed to Mycobacterium tuberculosis (Mtb), the risk of progressing to TB disease, and the risk of dying. However, an emerging body of evidence suggests that coinfection with cytomegalovirus (CMV), a ubiquitous herpes virus, impacts the host response to Mtb, potentially influencing the probability of disease progression, type of TB disease, performance of TB diagnostics, and disease outcome. It is also likely that infection with Mtb impacts CMV pathogenesis. Our current understanding of the burden of these 2 diseases in children, their immunological interactions, and the clinical consequence of coinfection is incomplete. It is also unclear how potential interventions might affect disease progression and outcome for TB or CMV. This article reviews the epidemiological, clinical, and immunological literature on CMV and TB in children and explores how the 2 pathogens interact, while also considering the impact of HIV on this relationship. It outlines areas of research uncertainty and makes practical suggestions as to potential studies that might address these gaps. Current research is hampered by inconsistent definitions, study designs, and laboratory practices, and more consistency and collaboration between researchers would lead to greater clarity. The ambitious targets outlined in the World Health Organization End TB Strategy will only be met through a better understanding of all aspects of child TB, including the substantial impact of coinfections.
Stockdale L, Sambou B, Sissoko M, et al., 2021, Vitamin D in Gambian children with discordant tuberculosis (TB) infection status despite matched TB exposure: a case control study, EUROPEAN JOURNAL OF PEDIATRICS, Vol: 181, Pages: 1263-1267, ISSN: 0340-6199
Hommes F, Monzo HB, Ferrand RA, et al., 2021, The words we choose matter: recognising the importance of language in decolonising global health, LANCET GLOBAL HEALTH, Vol: 9, Pages: E897-E898, ISSN: 2214-109X
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- Citations: 12
McArdle AJ, Vito O, Patel H, et al., 2021, Treatment of multisystem inflammatory syndrome in children, New England Journal of Medicine, Vol: 385, Pages: 11-22, ISSN: 0028-4793
BACKGROUNDEvidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.METHODSWe performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.RESULTSData were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.CONCLUSIONSWe found n
Basu Roy R, Bakeera-Kitaka S, Chabala C, et al., 2021, Defeating paediatric tuberculous meningitis: applying the WHO "Defeating Meningitis by 2030: Global Roadmap"., Microorganisms, Vol: 9, Pages: 1-18, ISSN: 2076-2607
Children affected by tuberculous meningitis (TBM), as well as their families, have needs that lie at the intersections between the tuberculosis and meningitis clinical, research, and policy spheres. There is therefore a substantial risk that these needs are not fully met by either programme. In this narrative review article, we use the World Health Organization (WHO) "Defeating Meningitis by 2030: global roadmap" as a starting point to consider key goals and activities to specifically defeat TBM in children. We apply the five pillars outlined in the roadmap to describe how this approach can be adapted to serve children affected by TBM. The pillars are (i) prevention; (ii) diagnosis and treatment; (iii) surveillance; (iv) support and care for people affected by meningitis; and (v) advocacy and engagement. We conclude by calling for greater integration between meningitis and TB programmes at WHO and at national levels.
Noguera-Julian A, Calzada-Hernandez J, Brinkmann F, et al., 2020, Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-alpha Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study, CLINICAL INFECTIOUS DISEASES, Vol: 71, Pages: 2561-2569, ISSN: 1058-4838
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- Citations: 10
García-Mingo A, Abbara A, Roy RB, 2020, "You said the hospital can't be bombed"., The Lancet Child and Adolescent Health, ISSN: 2352-4642
Basu Roy R, Sambou B, Sissoko M, et al., 2020, Protection against mycobacterial infection: A case-control study of mycobacterial immune responses in pairs of Gambian children with discordant infection status despite matched TB exposure, EBioMedicine, Vol: 59, Pages: 1-10, ISSN: 2352-3964
BackgroundChildren are particularly susceptible to tuberculosis. However, most children exposed to Mycobacterium tuberculosis are able to control the pathogen without evidence of infection. Correlates of human protective immunity against tuberculosis infection are lacking, and their identification would aid vaccine design.MethodsWe recruited pairs of asymptomatic children with discordant tuberculin skin test status but the same sleeping proximity to the same adult with sputum smear-positive tuberculosis in a matched case-control study in The Gambia. Participants were classified as either Highly TB-Exposed Uninfected or Highly TB-Exposed Infected children. Serial luminescence measurements using an in vitro functional auto-luminescent Bacillus Calmette–Guérin (BCG) whole blood assay quantified the dynamics of host control of mycobacterial growth. Assay supernatants were analysed with a multiplex cytokine assay to measure associated inflammatory responses.Findings29 pairs of matched Highly TB-Exposed Uninfected and Highly TB-Exposed Infected children aged 5 to 15 years old were enroled. Samples from Highly TB-Exposed Uninfected children had higher levels of mycobacterial luminescence at 96 hours than Highly TB-Exposed Infected children. Highly TB-Exposed Uninfected children also produced less BCG-specific interferon-γ than Highly TB-Exposed Infected children at 24 hours and at 96 hours.InterpretationHighly TB-Exposed Uninfected children showed less control of mycobacterial growth compared to Highly TB-Exposed Infected children in a functional assay, whilst cytokine responses mirrored infection status.FundingClinical Research Training Fellowship funded under UK Medical Research Council/Department for International Development Concordat agreement and part of EDCTP2 programme supported by European Union (MR/K023446/1). Also MRC Program Grants (MR/K007602/1, MR/K011944/1, MC_UP_A900/1122).
Cresswell F, Davis A, Sharma K, et al., 2020, Recent developments in Tuberculous meningitis pathogenesis and diagnostics [version 2; peer review: 1 approved], Wellcome Open Research, Vol: 4, ISSN: 2398-502X
The pathogenesis of Tuberculous meningitis (TBM) is poorly understood, but contemporary molecular biology technologies have allowed for recent improvements in our understanding of TBM. For instance, neutrophils appear to play a significant role in the immunopathogenesis of TBM, and either a paucity or an excess of inflammation can be detrimental in TBM. Further, severity of HIV-associated immunosuppression is an important determinant of inflammatory response; patients with the advanced immunosuppression (CD4+ T-cell count of <150 cells/μL) having higher CSF neutrophils, greater CSF cytokine concentrations and higher mortality than those with CD4+ T-cell counts > 150 cells/μL. Host genetics may also influence outcomes with LT4AH genotype predicting inflammatory phenotype, steroid responsiveness and survival in Vietnamese adults with TBM. Whist in Indonesia, CSF tryptophan level was a predictor of survival, suggesting tryptophan metabolism may be important in TBM pathogenesis. These varying responses mean that we must consider whether a “one-size-fits-all” approach to anti-bacillary or immunomodulatory treatment in TBM is truly the best way forward. Of course, to allow for proper treatment, early and rapid diagnosis of TBM must occur. Diagnosis has always been a challenge but the field of TB diagnosis is evolving, with sensitivities of at least 70% now possible in less than two hours with GeneXpert MTB/Rif Ultra. In addition, advanced molecular techniques such as CRISPR-MTB and metagenomic next generation sequencing may hold promise for TBM diagnosis. Host-based biomarkers and signatures are being further evaluated in childhood and adult TBM as adjunctive biomarkers as even with improved molecular assays, cases are still missed. A better grasp of host and pathogen behaviour may lead to improved diagnostics, targeted immunotherapy, and possibly biomarker-based, patient-specific treatment regimens.
White R, Roy RB, 2020, Projections of pregnancy: art as the voice for the unheard, LANCET CHILD & ADOLESCENT HEALTH, Vol: 4, Pages: 492-493, ISSN: 2352-4642
Roy RB, Thee S, Blazquez-Gamero D, et al., 2020, Performance of immune-based and microbiological tests in children with tuberculosis meningitis in Europe: a multicentre Paediatric Tuberculosis Network European Trials Group (ptbnet) study, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936
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- Citations: 15
Andreas NJ, Roy RB, Gomez-Romero M, et al., 2020, Performance of metabonomic serum analysis for diagnostics in paediatric tuberculosis, Scientific Reports, Vol: 10, Pages: 1-11, ISSN: 2045-2322
We applied a metabonomic strategy to identify host biomarkers in serum to diagnose paediatric tuberculosis (TB) disease. 112 symptomatic children with presumptive TB were recruited in The Gambia and classified as bacteriologically-confirmed TB, clinically diagnosed TB, or other diseases. Sera were analysed using 1H nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS). Multivariate data analysis was used to distinguish patients with TB from other diseases. Diagnostic accuracy was evaluated using Receiver Operating Characteristic (ROC) curves. Model performance was tested in a validation cohort of 36 children from the UK. Data acquired using 1H NMR demonstrated a sensitivity, specificity and Area Under the Curve (AUC) of 69% (95% confidence interval [CI], 56–73%), 83% (95% CI, 73–93%), and 0.78 respectively, and correctly classified 20% of the validation cohort from the UK. The most discriminatory MS data showed a sensitivity of 67% (95% CI, 60–71%), specificity of 86% (95% CI, 75–93%) and an AUC of 0.78, correctly classifying 83% of the validation cohort. Amongst children with presumptive TB, metabolic profiling of sera distinguished bacteriologically-confirmed and clinical TB from other diseases. This novel approach yielded a diagnostic performance for paediatric TB comparable to that of Xpert MTB/RIF and interferon gamma release assays.
Cresswell F, Davis A, Sharma K, et al., 2019, Recent developments in tuberculous meningitis pathogenesis and diagnostics [version 1; peer review: awaiting peer review], Wellcome Open Research, Vol: 4, Pages: 1-13, ISSN: 2398-502X
The pathogenesis of Tuberculous meningitis (TBM) is poorly understood, but contemporary molecular biology technologies have allowed for recent improvements in our understanding of TBM. For instance, neutrophils appear to play a significant role in the immunopathogenesis of TBM, and either a paucity or an excess of inflammation can be detrimental in TBM. Further, severity of HIV-associated immunosuppression is an important determinant of inflammatory response; patients with the advanced immunosuppression (CD4+ T-cell count of <150 cells/μL) having higher CSF neutrophils, greater CSF cytokine concentrations and higher mortality than those with CD4+ T-cell counts > 150 cells/μL. Host genetics may also influence outcomes with LT4AH genotype predicting inflammatory phenotype, steroid responsiveness and survival in Vietnamese adults with TBM. Whist in Indonesia, CSF tryptophan level was a predictor of survival, suggesting tryptophan metabolism may be important in TBM pathogenesis. These varying responses mean that we must consider whether a “one-size-fits-all” approach to anti-bacillary or immunomodulatory treatment in TBM is truly the best way forward. Of course, to allow for proper treatment, early and rapid diagnosis of TBM must occur. Diagnosis has always been a challenge but the field of TB diagnosis is evolving, with sensitivities of at least 70% now possible in less than two hours with GeneXpert MTB/Rif Ultra. In addition, advanced molecular techniques such as CRISPR-MTB and metagenomic next generation sequencing may hold promise for TBM diagnosis. Host-based biomarkers and signatures are being further evaluated in childhood and adult TBM as adjunctive biomarkers as even with improved molecular assays, cases are still missed. A better grasp of host and pathogen behaviour may lead to improved diagnostics, targeted immunotherapy, and possibly biomarker-based, patient-specific treatment regimens.
Roy RB, 2019, A prescription for cinematic lenses on child and adolescent health, LANCET CHILD & ADOLESCENT HEALTH, Vol: 3, Pages: 681-682, ISSN: 2352-4642
Darboe S, Dobreniecki S, Jarju S, et al., 2019, Prevalence of Panton-Valentine Leukocidin (PVL) and Antimicrobial Resistance in Community-Acquired Clinical Staphylococcus aureus in an Urban Gambian Hospital: A 11-Year Period Retrospective Pilot, FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY, Vol: 9, ISSN: 2235-2988
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- Citations: 33
Roy RB, Sambou B, Uhia I, et al., 2019, An auto-luminescent fluorescent BCG whole blood assay to enable evaluation of paediatric mycobacterial responses using minimal blood volumes, Frontiers in Pediatrics, Vol: 7, ISSN: 2296-2360
Introduction: Understanding protective human immunity against mycobacteria is critical to developing and evaluating new vaccines against tuberculosis. Children are the most susceptible population to infection, disease, and death from tuberculosis, but also have the strongest evidence of BCG-inducible protection. Limited amounts of blood can be obtained for research purposes in paediatrics and therefore there is a need for high-yield, low-volume, human immunology assays.Methods: We transformed BCG Danish with plasmids encoding luciferase full operon derived from Photorhabdus luminescens together with Green Fluorescent Protein and antibiotic selection markers. We characterised the luminescent and fluorescent properties of this recombinant BCG strain (BCG-GFP-LuxFO) using a luminometer and flow cytometry and developed a paediatric whole blood in vitro infection model.Results: Luminescence of BCG-GFP-LuxFO correlated with optical density (Spearman Rank Correlation coefficient r = 0.985, p < 0.0001) and colony forming units (CFUs) in liquid culture medium (r = 0.971, p < 0.0001). Fluorescence of BCG-GFP-LuxFO in paediatric whole blood was confirmed by flow cytometry in granulocytes and monocytes 1 h following infection. Luminescence of BCG-GFP-LuxFO in whole blood corresponded with CFUs (r = 0.7123, p < 0.0001).Conclusion: The BCG-GFP-LuxFO assay requires 225 μL whole blood per sample, from which serial luminescence measurements can be obtained, together with biochemical analysis of supernatants and cellular assay applications using its fluorescent properties. This offers the opportunity to study human-mycobacterial interactions using multiple experimental modalities with only minimal blood volumes. It is therefore a valuable method for investigating paediatric immunity to tuberculosis.
Basu Roy R, Whittaker E, Seddon JA, et al., 2019, Tuberculosis susceptibility and protection in children, Lancet Infectious Diseases, Vol: 19, Pages: e96-e108, ISSN: 1473-3099
Children represent both a clinically important population susceptible to tuberculosis and a key group in whom to study intrinsic and vaccine-induced mechanisms of protection. After exposure to Mycobacterium tuberculosis, children aged under 5 years are at high risk of progressing first to tuberculosis infection, then to tuberculosis disease and possibly disseminated forms of tuberculosis, with accompanying high risks of morbidity and mortality. Children aged 5–10 years are somewhat protected, until risk increases again in adolescence. Furthermore, neonatal BCG programmes show the clearest proven benefit of vaccination against tuberculosis. Case-control comparisons from key cohorts, which recruited more than 15 000 children and adolescents in total, have identified that the ratio of monocytes to lymphocytes, activated CD4 T cell count, and a blood RNA signature could be correlates of risk for developing tuberculosis. Further studies of protected and susceptible populations are necessary to guide development of novel tuberculosis vaccines that could facilitate the achievement of WHO's goal to eliminate deaths from tuberculosis in childhood.
Antolin LF, Kadambari S, Braccio S, et al., 2018, Increased detection of human parechovirus infection in infants in England during 2016: epidemiology and clinical characteristics, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 103, Pages: 1061-1066, ISSN: 0003-9888
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- Citations: 19
Kampmann B, Seddon JA, Paton J, et al., 2018, Evaluating UK National Guidance for Screening of Children for TB: A prospective multi-centre study, American Journal of Respiratory and Critical Care Medicine, Vol: 197, Pages: 1058-1064, ISSN: 1073-449X
Rationale and Objective In order to identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of interferon-gamma release assays (IGRA) to the tuberculin skin test (TST) in its 2006 TB guidelines. Treatment for TB infection was no longer recommended for children screened TST-positive but IGRA-negative. We carried out a cohort study to evaluate the risk of TB disease in this group. Methods Children exposed to an infectious case of TB in their household were recruited from 11 paediatric TB clinics. TST and IGRA were carried out at baseline, IGRA repeated at 8 weeks and TST repeated if initially negative. Children were treated according to 2006 NICE guidelines and followed for 24 months. Measurements and Main Results Of 431 recruited children 392 completed the study. We diagnosed 48 (12.2%) cases of prevalent TB disease, 105 (26.8%) with TB infection and 239 (60.9%) without TB infection or disease. 18 children aged two years and above had a positive TST but persistently negative IGRA. None received TB infection treatment and none developed TB disease. 90 (26.1%) children qualified for TB infection treatment according to 2006 NICE guidelines. In contrast, 147 (42.7%) children would have qualified under revised NICE guidance, issued in 2016. Conclusions In this low prevalence setting we saw no incident cases of TB disease in children who were TST-positive but IGRA-negative and did not receive treatment for TB infection. Following the latest NICE guidance, significantly more children will require medication.
Basu Roy R, Seddon JA, 2017, Linezolid for children with tuberculous meningitis: more evidence required, Pediatric Infectious Disease Journal, Vol: 36, Pages: 439-439, ISSN: 1532-0987
Broger T, Basu Roy R, Filomena A, et al., 2017, Diagnostic performance of tuberculosis-specific IgG antibody profiles in patients with presumptive tuberculosis from two continents, Clinical Infectious Diseases, Vol: 64, Pages: 947-955, ISSN: 1537-6591
Background. Development of rapid diagnostic tests for tuberculosis is a global priority. A whole proteome screen identifiedMycobacterium tuberculosis antigens associated with serological responses in tuberculosis patients. We used World HealthOrganization (WHO) target product profile (TPP) criteria for a detection test and triage test to evaluate these antigens.Methods. Consecutive patients presenting to microscopy centers and district hospitals in Peru and to outpatient clinics at atuberculosis reference center in Vietnam were recruited. We tested blood samples from 755 HIV–uninfected adults with presumptivepulmonary tuberculosis to measure IgG antibody responses to 57 M. tuberculosis antigens using a field-based multiplexed serologicalassay and a 132-antigen bead-based reference assay. We evaluated single antigen performance and models of all possible 3-antigencombinations and multiantigen combinations.Results. Three-antigen and multiantigen models performed similarly and were superior to single antigens. With specificityset at 90% for a detection test, the best sensitivity of a 3-antigen model was 35% (95% confidence interval [CI], 31–40). Withsensitivity set at 85% for a triage test, the specificity of the best 3-antigen model was 34% (95% CI, 29–40). The reference assayalso did not meet study targets. Antigen performance differed significantly between the study sites for 7/22 of the best-performingantigens.Conclusions. Although M. tuberculosis antigens were recognized by the IgG response during tuberculosis, no single antigen ormultiantigen set performance approached WHO TPP criteria for clinical utility among HIV-uninfected adults with presumed tuberculosisin high-volume, urban settings in tuberculosis-endemic countries.
Basu Roy R, Brandt N, Moodie N, et al., 2016, Why the Convention on the Rights of the Child must become a guiding framework for the realization of the rights of children affected by tuberculosis, BMC International Health and Human Rights, Vol: 16, ISSN: 1472-698X
BackgroundUntil recently, paediatric tuberculosis (TB) has been relatively neglected by the broader TB and the maternal and child health communities. Human rights-based approaches to children affected by TB could be powerful; however, awareness and application of such strategies is not widespread. DiscussionWe summarize the current challenges faced by children affected by TB, including: consideration of their family context; the limitations of preventive, diagnostic and treatment options; paucity of paediatric-specific research; failure in implementation of interventions; and stigma. We examine the articles of the Convention on the Rights of the Child (CRC) and relate them to childhood TB. Specifically, we focus on the five core principles of the CRC: children’s inherent right to life and States’ duties towards their survival and development; children’s right to enjoyment of the highest attainable standard of health; non-discrimination; best interests of the child; and respect for the views of the child. We highlight where children’s rights are violated and how a human rights-based approach should be used as a tool to help children affected by TB, particularly in light of the Sustainable Development Goals and their focus on universality and leaving no one behind. SummaryThe article aims to bridge the gap between those providing paediatric TB clinical care and conducting research, and those working in the fields of human rights policy and advocacy to promote a human rights-based approach for children affected by TB based upon the Convention on the Rights of the Child.
Long J, Basu Roy R, Zhang YJ, et al., 2016, Plasma Membrane Profiling Reveals Upregulation of ABCA1 by Infected Macrophages Leading to Restriction of Mycobacterial Growth, Frontiers in Microbiology, Vol: 7, ISSN: 1664-302X
The plasma membrane represents a critical interface between the internal and extracellular environments, and harbors multiple proteins key receptors and transporters that play important roles in restriction of intracellular infection. We applied plasma membrane profiling, a technique that combines quantitative mass spectrometry with selective cell surface aminooxy-biotinylation, to Bacille Calmette–Guérin (BCG)-infected THP-1 macrophages. We quantified 559 PM proteins in BCG-infected THP-1 cells. One significantly upregulated cell-surface protein was the cholesterol transporter ABCA1. We showed that ABCA1 was upregulated on the macrophage cell-surface following infection with pathogenic mycobacteria and knockdown of ABCA1 resulted in increased mycobacterial survival within macrophages, suggesting that it may be a novel mycobacterial host-restriction factor.
Fullerton L, Norrish G, Wedderburn CJ, et al., 2015, Nosocomial Neonatal Listeria monocytogenes Transmission by Stethoscope, Pediatric Infectious Disease Journal, Vol: 34, Pages: 1042-1043, ISSN: 1532-0987
Amer K, Roy RB, Parslow R, et al., 2013, GENDER MORTALITY DIFFERENCES OF INFANTS ON PICU, 24th Annual Meeting of the European-Society-of-Paediatric-and-Neonatal-Intensive-Care, Publisher: SPRINGER, Pages: S76-S76, ISSN: 0342-4642
Williams B, Ramroop S, Shah P, et al., 2013, Multidrug-resistant tuberculosis in UK children: presentation, management and outcome, EUROPEAN RESPIRATORY JOURNAL, Vol: 41, Pages: 1456-1458, ISSN: 0903-1936
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- Citations: 8
Pollock L, Basu Roy R, Kampmann B, 2013, How to use: interferon γ release assays for tuberculosis, Arch Dis Child Educ Pract Ed
Basu Roy R, Rubin EJ, 2013, Tuberculosis, The Prokaryotes, Editors: Rosenberg, DeLong, Lory, Stackebrandt, Thompson, Publisher: Springer Berlin Heidelberg, Pages: 133-133, ISBN: 978-3-642-30144-5
Mycobacterium tuberculosis is an obligate human pathogen of immense importance, infecting up to one third of the human population and causing 1.4 million deaths per year. Despite a long-established vaccine and initially effective antibiotics, M. tuberculosis continues to be a scourge of mankind through a combination of factors: related to the organism, host, their interaction, co-infections such as with HIV, and societal issues. The hallmark of M. tuberculosis as a pathogen is its intracellular growth and ability to evade killing by macrophages, including latent infection for many years. Here we consider distinctive characteristics of the organism, pathogenesis, epidemiology, clinical syndrome, diagnosis, treatment, and prevention of tuberculosis. Pressing challenges include combating drug resistance, designing better vaccines, improved diagnostics, and simplified treatment regimes. Molecular techniques are increasingly being transferred from bench to bedside and the coordinated efforts of microbiologists, immunologists, epidemiologists, clinicians, and policy-makers are required to turn the tide against tuberculosis.
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