الفهرس 
List of ContentsOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
Latent tuberculosis infection (LTBI) is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB . As there is no “gold standard” test for LTBI, the global burden is not known with certainty; however, up to one third of the world’s population is estimated to be infected with M. tuberculosis and the vast majority have no signs or symptoms of TB disease and are not infectious, although they are at risk for active TB disease and for becoming infectious. Several studies have shown that, on average, 5–10% of those infected will develop active TB disease over the course of their lives, usually within the first 5 years after initial infection The risk for active TB disease after infection depends on several factors, the most important being immunological status . Prevention of active TB disease by treatment of LTBI is a critical component of the WHO End TB Strategy . The efficacy of currently available treatments ranges from 60% to 90% . The potential benefit of treatment should, however, be carefully balanced against the risk for drug-related adverse events. Mass, populationwide LTBI testing and treatment are not feasible because the tests are imperfect, there are risks of serious and fatal side-effects, and the cost would be high, for an unproven public health impact. For infected individuals in population groups in which the risk for progression to active disease significantly exceeds that of the general population, however, the benefits are greater than the harm. Management of LTBI involves a comprehensive package of interventions: identifying and testing those individuals who should be tested, delivering effective, safe treatment in such a way that the majority of those starting a treatment regimen will complete it with no or minimal risk of adverse events, and monitoring and evaluation of the process. In addition to young children, the risk of progression from LTBI to active TB is higher in people coinfected with HIV, patients immunocompromised because of comorbidity (e.g. diabetes, malignancy, renal disease) and/or people with long-term use of immunosuppressant medications [e.g. corticosteroids, tumour necrosis factor alpha (TNF-α) antagonists] Targeted tuberculin skin testing remains the most acceptable method of LTBI screening. New tests are being developed, the most promising of which are in vitro interferon-gamma release assays. All screened persons found to have LTBI should be offered treatment, regardless of age. The study is aimed is to identify the prevalence of latent tuberculosis (according to new guideline; NICE tuberculosis) among these high risk groups of children. This is an epidemiological study, was conducted on 70 patients admitted to the nephrology unit and endocrinology, Children hospital, Assiut University during a period of one year duration. The main results of the study revealed that: The mean age of the study group was 6.73±3.58 years with patient ≤ 5 years represent 33(47.1%) and those > 5 years represent 37(52.9%).The majority of patients were males in the study group [40(57.14%)].Mean height 116.16±18.1, mean weight 22.46±9.78 and mean BMI 15.92±3.24. Two study groups (two risk factors) included in the study which is CKD (chronic kidney disease ) (n=35 & 50%) that divided into 10 cases (14.29%) on haemodialysis , 12 cases stage III (17.14%) and 13 cases satge IV (18.57%) CKD . The other risk facror is DM (diabetes mellitus) ( n=35 & 50%) . Percentige of cases with positive result of TST test Which is 5.7 % of toatal cases included in study groups with significant p value (<0.001). Comparison between demographic data according to TST result that show male predominance in positive cases with 75% of positive cases opposite 25% female cases but in comparision with negative cases there is insignificant value (p value = .457). For age groups comparision between cases under 5 years and cases above 5 years show that insignficant difference between positive and negative cases in both age groups with p value = .245 & with insignificant mean age differences between positive and negative results with p value = .229There is insignificant differences between mean weight, mean height and mean BMI between positive and negative cases with p value = .276, .342 and .422 respectively. Comparison between CKD and DM data according to TST results showing that from 4 cases with positive TST result , 3 cases have CKD and 1 case only have DM but with insignificant diffirence (p value = .480 ) & also in same group study (risk factor) there is insignificant difference between positive and negative cases with CKD ( p value = .639) and insignificant difference between positive and negative cases with DM (p value .749). Comparison between demographic data according to two study groups (risk factors) showing that more male with CKD (n=23 & 65%) than male with DM (n=17 & 48.6%) and more female with DM (n=18 & 51%) than female with CKD (n=12 & 34.3) but with insignificant difference (p value = .147). For age group comparison according to risk factor, results show more patient with age below 5 years old with CKD (n=19 & 54.3%) than that with DM (n=14 & 40%) but with insignificant value (p value = .231). For weight comparision, mean weight seem nearly equal between cases with CKD and DM (22.2±11.22 & 22.71±8.26 repectively) with insignificant diffirence (p value = .828). For height comparision, mean height incases with DM (118.74±15.22) more than that in CKD (113.57±20.47) but with insignificant difference (p value = 0.235). For BMI comparision, mean BMI seem nearly equal between cases with CKD and DM (16.23±3.59 & 15.62±2.87 respectively) with insignificant difference (p value = 0.433). Comparison between TST results according to risk factors showing positive cases with CKD (n=3 & 8.6) more than that with DM (n= 1 & 2.9) but with insignificant difference (p value = .610). but Comparison between CKD sub groups and DM risk factors according to TST result showing that all 3 positive cases in CKD risk factor group was on haemodialysis out of 10 cases on haemodyalsis included in the study with significant p value (0.005**)But in comparision between positive cases with CKD (n=3 & 8.6%) and negative cases with CKD (n= 32 & 91.4 %) there is significant difference with p value < 0.001). in comparision between positive cases with DM (n=1 & 2.9%) and negative cases with DM (n= 34 & 97.1 %) there is significant difference with p value < 0.001). So we concluded from our study that Prevalence of latent tuberculosis in children attending assiut university children hospital nearly average about 5.7 % , even low in percentage but should be put into consideration and be treated so that helping in decreasing incidence of Active tuberculosis in our locality , LTBI appear to be more in males than in females in our children attending assiut university children hospital , Median age of children affected by LTBI in our area appear to be 4.63±2.98 ( range 2.5 -9) , LTBI in chronic kidney disease ( CKD )appear to be more than in Dibetes mellitus (DM) in children included in that study and patients with ESKD ( on haemodialysis ) are more susceptible to develop LTBI than others with CKD . Based on our results we recommend Follow up positive cases for TB conversion and offer treatment, further studies in other risk factors , Further studies on patients with ESKD ( on haemodialysis ) and further multicenter studies are needed to evaluate prevalence of LTBI in our country.