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Introduction: The QuantiFERON-TB Gold Plus (QFT-Plus) assay, which features two antigen-stimulated tubes (TB1 and TB2) instead of a single tube used in previous-generation interferon-gamma release assays (IGRAs), was launched in 2016. Despite this, data regarding the assay's performance in the paediatric setting remain scarce. This study aimed to determine the performance of QFT-Plus in a large cohort of children and adolescents at risk of tuberculosis (TB) in a low-burden setting.Methods: Cross-sectional, multicentre study at healthcare institutions participating in the Spanish Paediatric TB Research Network, including patients <18 years who had a QFT-Plus performed between September 2016 and June 2020.Results: Of 1726 patients (52.8% male, median age: 8.4 years), 260 (15.1%) underwent testing during contact tracing, 288 (16.7%) on clinical/radiological suspicion of tuberculosis disease (TBD), 649 (37.6%) during new-entrant migrant screening and 529 (30.6%) prior to initiation of immunosuppressive treatment. Overall, the sensitivity of QFT-Plus for TBD (n=189) and for latent tuberculosis infection (LTBI, n=195) was 83.6% and 68.2%, respectively. The agreement between QFT-Plus TB1 and TB2 antigen tubes was excellent (98.9%, κ=0.961). Only five (2.5%) patients with TBD had discordance between TB1 and TB2 results (TB1+/TB2-, n=2; TB1-/TB2+, n=3). Indeterminate assay results (n=54, 3.1%) were associated with young age, lymphopenia and elevated C reactive protein concentrations.Conclusions: Our non-comparative study indicates that QFT-Plus does not have greater sensitivity than previous-generation IGRAs in children in both TBD and LTBI. In TBD, the addition of the second antigen tube, TB2, does not enhance the assay's performance substantially. [ABSTRACT FROM AUTHOR]

The impact of immunosuppression on interferon-γ release assays and novel cytokine biomarkers of TB infection, mycobacteria-specific IL-2, IP-10 and TNF-α responses was investigated in an ex vivo model. Cytokine responses in standard QuantiFERON-TB Gold in-Tube (QFT-GIT) assays were compared with duplicate assays containing dexamethasone or infliximab. Dexamethasone converted QFT-GIT results from positive to negative in 30% of participants. Antigen-stimulated interferon-γ, IL-2 and TNF-α responses were markedly reduced, but IP-10 responses were preserved. Infliximab caused QFT-GIT result conversion in up to 30% of participants and substantial reductions in all cytokine responses. Therefore, corticosteroids and anti-TNF-α agents significantly impair interferon-γ release assay performance. IP-10 may be a more robust TB biomarker than interferon-γ in patients receiving corticosteroids. [ABSTRACT FROM AUTHOR]

Objective Recent studies found that a chest x-ray (CXR) has limited value in the assessment of asymptomatic adults with tuberculosis (TB) infection. We aimed to determine in asymptomatic children with a positive tuberculin skin test and/or interferon-? release assay (TST/IGRA) whether a CXR identifies findings suggestive of pulmonary TB. Design, setting and patients All children with TB infection (defined as TST =10 mm and/or positive IGRA) presenting to The Royal Children's Hospital Melbourne during a 54-month period were included. All CXRs were reviewed by a senior radiologist blinded to the clinical details. The medical records of those with radiological abnormalities suggestive of TB were examined to identify those who were asymptomatic when the CXR was done. Demographical data were also collected. Results CXRs were available for 268 of 330 TBinfected children, of whom 60 had CXR findings suggestive of TB. Of the 57 for whom clinical details were available, 26 were asymptomatic. Of these asymptomatic children with radiological abnormalities suggestive of TB, 6 had CXR findings suggestive of active TB, 14 had CXR findings suggestive of prior TB and 6 had isolated non-calcified hilar lymphadenopathy. The six with findings suggestive of active TB represented 2.6% (95% CI 0.9 to 5.5%) of asymptomatic TST/IGRApositive children with evaluable CXRs. One child with isolated hilar lymphadenopathy had microbiologically confirmed TB. Conclusions In contrast to the results from studies in adults, a CXR identified a small but noteworthy number of children with findings suggestive of pulmonary TB in the absence of clinical symptoms. [ABSTRACT FROM AUTHOR]

The article provides an answer to a question of how do febrile convulsions cause cerebrospinal fluid (CSF) pleocytosis.

The article discusses the frequency of co-existing meningitis in infants with urinary tract infection (UTI). UTI are common. 1% and 15% of young children presenting with fever in the outpatient setting have UTI. In comparison to older children, UTI in infants is more commonly linked with bacteraemia, happening in 4-12% of cases.

The article discusses the efficacy of oestrogen cream in treating labial adhesions in girls. Five studies involving treatment of labial adhesions with oestrogen cream are cited, indicating a success rate of 47.7 percent to 100 percent. Topical treatment with oestrogen creams is effective in the majority of patients and that it could treat symptomatic prepubertal girls. Treatment must be administered in several weeks to achieve labial separation and surgery must be made for severe cases.

A letter to the editor is presented in response to the article "Screening Tests for Tuberculosis Before Starting Biological Therapy" by R. J. Hewitt and colleagues in the March 5, 2015 issue.

A letter to the editor is presented in response to the article "Interferon-gamma release assay for the diagnosis of tuberculosis in children" by A. Mendez-Echevarria, M. Gonzalez-Munoz and M.J. Mellado in the previous issue of the periodical.

A quiz about the diagnosis of a 2 year old girl with fever, cough and tachypnoea is presented.

The article focuses on a study that examines the usage of calamine lotion or antihistamines to provide symptomatic relief from pruritus in children with varicella zoster infection. Based on various publications and research, the use of calamine and antihistamines on varicella has no relevant results. No studies have examined the effect of calamine lotion on pruritus associated with varicella zoster infection. However, the use of zinc silicate and dimenthindene maleate report symptomatic relief.

The 11th revision of the International Classification of Diseases (ICD-11) proposed by the WHO is currently in the consultation phase. In common with previous versions of the ICD this revised version does not contain a code for latent tuberculosis infection (LTBI), contrasting with the inclusion of a large number of codes for various manifestations of active tuberculosis (TB). Inclusion of a separate code for LTBI into ICD-11 is critically important for epidemiological, clinical and research purposes. On behalf of the Paediatric Tuberculosis Network European Trials group, we encourage colleagues worldwide who are caring for TB patients or are involved in TB research to join us in supporting the case for a long overdue ICD code for LTBI. [ABSTRACT FROM AUTHOR]