SARS-CoV-2 coinfection in children with severe airway obstruction due to pulmonary tuberculosis.

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Pulmonology Pub Date : 2024-12-01 Epub Date: 2024-08-26 DOI:10.1002/ppul.27232

P Goussard, L Van Wyk, S Venkatakrishna, H Rabie, P Schubert, L Frigati, G Walzl, C Burger, A Doruyter, S Andronikou, A G Gie, D Rhode, C Jacobs, M Van der Zalm

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引用次数: 0

Abstract

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a significant impact on tuberculosis (TB) control globally, with the number of new TB diagnoses decreasing. Coinfection with some viruses, especially measles, could aggravate TB in children. This is presumably a result of depressed cellular immunity. Reports on children with TB and SARS-CoV-2 coinfection are limited.

Methods: A retrospective analysis of children up to 13 years old admitted to Tygerberg Hospital, Cape Town, South Africa, from March 2020 to December 2022 with suspected TB-induced airway compression requiring bronchoscopy. Children were included if they presented with severe intrathoracic airway obstruction and/or radiographic evidence of complicated TB. The patients were divided into two groups based on SARS-CoV-2 respiratory polymerase chain reaction results. Demographics, TB exposure, microbiology, SARS-CoV-2 laboratory data, imaging, inflammatory cytokine levels, and bronchoscopy data were collected. Statistical analyses compared SARS-CoV-2 positive and negative groups.

Results: Of the 50 children undergoing bronchoscopy for TB airway obstruction, 7 (14%) were SARS-CoV-2 positive. Cough was more prevalent in the SARS-CoV-2 positive group (p = 0.04). There was no difference in TB culture yield between groups. However, SARS-CoV-2 positive children showed slower radiological improvement at 1 month (p = 0.01), pleural effusions (p < 0.001), and a higher need for endoscopic enucleation (p < 0.001). FDG PET/CT scans indicated an ongoing inflammation in the SARS-CoV-2 positive group.

Conclusions: Coinfection with SARS-CoV-2 in children with TB airway obstruction appears to complicate the disease course, necessitating more medical interventions and demonstrating a longer duration of the TB inflammatory process. Further research is needed to understand the impact of viral infections on TB progression and outcomes in pediatric patients.

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因肺结核导致严重气道阻塞的儿童中的 SARS-CoV-2 合并感染。

导言：严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）大流行对全球结核病（TB）控制产生了重大影响，新诊断的结核病人数有所下降。合并感染某些病毒，尤其是麻疹病毒，会加重儿童结核病的病情。这可能是细胞免疫功能低下的结果。有关儿童结核病和 SARS-CoV-2 合并感染的报道非常有限：回顾性分析 2020 年 3 月至 2022 年 12 月期间在南非开普敦 Tygerberg 医院住院的 13 岁以下儿童，这些儿童疑似因肺结核导致气道受压，需要进行支气管镜检查。如果儿童出现严重的胸内气道阻塞和/或有并发肺结核的影像学证据，则将其纳入研究范围。根据 SARS-CoV-2 呼吸道聚合酶链反应结果将患者分为两组。研究人员收集了患者的人口统计学资料、结核病接触史、微生物学资料、SARS-CoV-2 实验室数据、影像学资料、炎症细胞因子水平以及支气管镜检查数据。统计分析比较了 SARS-CoV-2 阳性组和阴性组：结果：在因肺结核气道阻塞而接受支气管镜检查的 50 名儿童中，有 7 名（14%）SARS-CoV-2 阳性。SARS-CoV-2 阳性组的咳嗽发生率更高（P = 0.04）。各组之间的结核菌培养率没有差异。不过，SARS-CoV-2 阳性儿童在 1 个月后的放射学改善较慢（P = 0.01），胸腔积液（P = 0.01）和肺结核（P = 0.01）的改善较慢（P = 0.01）：肺结核气道阻塞患儿合并感染 SARS-CoV-2 似乎会使病程复杂化，需要更多的医疗干预措施，并显示肺结核炎症过程持续时间更长。要了解病毒感染对结核病进展和儿童患者预后的影响，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Pulmonology 医学-呼吸系统

CiteScore

6.00

自引率

12.90%

发文量

468

审稿时长

3-8 weeks

期刊介绍： Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases. PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.